Prevalence and Risk Factors of Intensive Care Unit-acquired Weakness in Patients With COVID-19

A Systematic Review and Meta-analysis

Chuang, Ya-Chi MD
Shiu, Sz-Iuan MD
Lee, Yu-Chun MD, MHA
Tsai, Yu-Lin MD
Cheng, Yuan-Yang MD, PhD

¹Department of Physical Medicine and Rehabilitation, 40293Taichung Veterans General Hospital, Taichung, Taiwan, ROC
²Division of Gastroenterology and Hepatology, Department of Internal Medicine, 40293Taichung Veterans General Hospital, Taichung, Taiwan, ROC
³Department of Critical Care Medicine, 40293Taichung Veterans General Hospital, Taichung, Taiwan, ROC
⁴Evidence-Based Practice and Policymaking Committee, 40293Taichung Veterans General Hospital, Taichung, Taiwan, ROC
⁵Department of Exercise Health Science, 145475National Taiwan University of Sport, Taichung, Taiwan, ROC
⁶Department of Industrial Engineering and Enterprise Information, 34890Tunghai University, Taichung, Taiwan, ROC
⁷Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan, ROC
⁸Department of Post-Baccalaureate Medicine, College of Medicine, 34916National Chung Hsing University, Taichung, Taiwan

Yu-Lin Tsai, Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung 407219, Taiwan, ROC. Email: [email protected]

Yuan-Yang Cheng, Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung 407219, Taiwan, ROC. Email: [email protected]

Received March 22, 2024

Received in revised form June 2, 2024

Accepted July 1, 2024

Journal of Intensive Care Medicine 40(10):p 1042-1051, October 2025. | DOI: 10.1177/08850666241268437

Background

Intensive care unit acquired weakness (ICUAW) is a common neuromuscular complication of critical illness, impacting patients’ recovery and long-term outcomes. However, limited evidence is available on pooled prevalence and risk factors of ICUAW specifically in the COVID-19-infected population.

Methods

We searched on PubMed, Embase, Cochrane Library, Web of Science, PEDro, and EBSCOhost/CINAHL up to January 31, 2024. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and odds ratios with corresponding 95% confidence intervals was used to identify risk factors.

Results

The pooled prevalence of ICUAW in COVID-19 patients was 55% in eight studies on 868 patients. Risk factors for developing ICUAW in these patients were: old age (WMD 4.78, 95% CI, 1.06-8.49), pre-existing hypertension (OR = 1.63, 95% CI, 1.02-2.61), medical intervention of prone position (OR = 5.21, 95% CI, 2.72-9.98), use of neuromuscular blocking agents (NMBA) (OR = 12.04, 95% CI, 6.20-23.39), needed tracheostomy (OR = 18.07, 95% CI, 5.64-57.92) and renal replacement therapy (RRT) (OR = 5.24, 95% CI = 2.36-11.63).

Conclusions

The prevalence of ICUAW in patients with COVID-19 was considered relatively high. Older age, pre-existing hypertension, medical intervention of prone position, NMBA use, needed tracheostomy and RRT were likely risk factors. In the future, interdisciplinary medical team should pay attention to high-risk groups for ICUAW prevention and early treatments.