Risk Factors, Diagnostic Challenges, and Emerging Therapeutic Strategies for ICU-Acquired Weakness: A Brief Review

Abstract

Intensive care unit-acquired weakness (ICU-AW) is a common complication in critically ill patients, associated with multiple risk factors and significantly impacting long-term patient outcomes. Currently, early diagnosis remains a key challenge in managing ICU-AW: clinical scales are limited by subjectivity, while muscle ultrasound and emerging biomarkers (such as the creatinine/cystatin C ratio, miR-451a, and MuRF1), though showing potential for early identification, have not yet been widely adopted in clinical practice. In terms of management, prevention is paramount. The ABCDEF bundle emphasizes early mobilization (initiated within 24–72 hours), while nutritional strategies targeting molecular pathways (such as HMB and ω-3 fatty acids) help regulate protein metabolism balance. Novel targeted therapies (eg, the myostatin inhibitor Bimagrumab) have demonstrated potential to increase muscle mass in clinical trials. Currently, early diagnosis remains the critical barrier. This review aims to synthesize the latest evidence on the risk factors, diagnostic challenges, and management strategies for ICU-AW, providing insights for clinical practice. It also underscores the need for future research to focus on developing highly sensitive diagnostic tools, optimizing preventive strategies, and promoting the clinical translation of targeted therapies. Ultimately, this will help establish a comprehensive and precise multi-level intervention framework to improve patient outcomes.