title: The ICM research agenda on intensive care unit-acquired weakness.
abstract: We present areas of uncertainty concerning intensive care unit-acquired weakness (ICUAW) and identify areas for future research. Age, pre-ICU functional and cognitive state, concurrent illness, frailty, and health trajectories impact outcomes and should be assessed to stratify patients. In the ICU, early assessment of limb and diaphragm muscle strength and function using nonvolitional tests may be useful, but comparison with established methods of global and specific muscle strength and physical function and determination of their reliability and normal values would be important to advance these techniques. Serial measurements of limb and respiratory muscle strength, and systematic screening for dysphagia, would be helpful to clarify if and how weakness of these muscle groups is independently associated with outcome. ICUAW, delirium, and sedatives and analgesics may interact with each other, amplifying the effects of each individual factor. Reduced mobility in patients with hypoactive delirium needs investigations into dysfunction of central and peripheral nervous system motor pathways. Interventional nutritional studies should include muscle mass, strength, and physical function as outcomes, and prioritize elucidation of mechanisms. At follow-up, ICU survivors may suffer from prolonged muscle weakness and wasting and other physical impairments, as well as fatigue without demonstrable weakness on examination. Further studies should evaluate the prevalence and severity of fatigue in ICU survivors and define its association with psychiatric disorders, pain, cognitive impairment, and axonal loss. Finally, methodological issues, including accounting for baseline status, handling of missing data, and inclusion of patient-centered outcome measures should be addressed in future studies.
authors.affiliation: Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. nicola.latronico@unibs.it.|Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy. nicola.latronico@unibs.it.
authors.forename: Nicola
authors.identifier: 0000-0002-2521-5871
authors.initials: N
authors.lastname: Latronico
authors.affiliation: Interdepartmental Division of Critical Care Medicine, Institute of Medical Science, Toronto General Research Institute, University of Toronto, University Health Network, Toronto, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Herridge
authors.affiliation: Pulmonary and Critical Care Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA.|Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA.
authors.forename: Ramona O
authors.initials: RO
authors.lastname: Hopkins
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh Schools of Medicine, Pittsburgh, PA, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Angus
authors.affiliation: St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hart
authors.affiliation: Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Louvain, Belgium.|Medical Intensive-Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Louvain, Belgium.
authors.forename: Greet
authors.initials: G
authors.lastname: Hermans
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.|Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Iwashyna
authors.affiliation: Intensive Care Department, Respiratory Services, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Arabi
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.|Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Citerio
authors.affiliation: Department of Medicine, Pulmonary and Critical Care and Health Services, Research Center, Vanderbilt University School of Medicine, Nashville, TN, USA.|The Tennessee Valley Veteran's Affairs Geriatric Research Education, Clinical Center (GRECC), Nashville, TN, USA.
authors.forename: E. Wesley
authors.initials: EW
authors.lastname: Ely
authors.affiliation: University of Chicago, Chicago, IL, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Hall
authors.affiliation: Department of Medicine, Sinai Health System, Toronto, Canada.|Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Department of Physiological Nursing, University of California, San Francisco, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Puntillo
authors.affiliation: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Van den Hoeven
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada.|Interdepartmental Division of Critical Care Medicine, Department of Anesthesia, University of Toronto, Toronto, ON, Canada.
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.|Department of Critical Care, St Joseph's Healthcare, Hamilton, ON, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.affiliation: Keenan and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.|Interdepartmental Division of Critical Care, Department of Medicine and Institute of Medical Sciences, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Claudia
authors.initials: C
authors.lastname: Dos Santos
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.|Program in Trauma, Emergency and Critical Care, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Rubenfeld
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: Department and Laboratory of Intensive Care Medicine, KU Leuven, Louvain, Belgium.
authors.forename: Greet
authors.initials: G
authors.lastname: Van den Berghe
authors.affiliation: Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Outcomes After Critical Illness and Surgery (OACIS) Group, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000367:Age Factors; D035843:Biomedical Research; D003422:Critical Care; D003680:Deglutition Disorders / Q000150:complications; D003693:Delirium / Q000150:complications; D000073496:Frailty / Q000209:etiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D053580:Muscle Strength / Q000502:physiology*; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D009468:Neuromuscular Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D012137:Respiratory System / Q000503:physiopathology
keywords: Disability; Fatigue; Muscle weakness; Myopathy; Pain; Physical impairment; Polyneuropathy