Physiotherapy management of intensive care unit-acquired weakness

Intensive care unit-acquired weakness (ICUAW) is a common condition in critically ill patients who are mechanically ventilated for prolonged periods of time.1 Only recently have mechanistic studies shown that muscle atrophy and loss of muscle mass develop rapidly during critical illness – within hours of the patient being intubated and mechanically ventilated.2 Physiotherapists play an integral role in the prevention and treatment of ICUAW within the intensive care unit (ICU), with studies showing benefit from early mobilisation and inspiratory muscle training for patients in the ICU to improve duration of weaning and functional independence at hospital discharge.3, 4 Most importantly, as survival from ICU increases, physiotherapists will have a greater role in the management of ICUAW after discharge from ICU and hospital.This review summarises the pathophysiology of ICUAW; the diagnosis during critical illness; the respiratory and musculoskeletal consequences of ICUAW; the burden of ICUAW on survivors of critical illness and their families; strategies to prevent and manage ICUAW, with a focus on specific physiotherapy interventions during critical illness; and future directions for research and practice.