A new era for ICU-acquired weakness research—from mechanisms to meaningful recovery

Abstract

Intensive care unit-acquired weakness (ICUAW) remains one of the most persistent and disabling sequelae of critical illness.Despite decades of research and a growing emphasis on survivorship, our understanding of its mechanisms, prevention, and management remains incomplete.In a recent issue of Intensive Care Medicine, Eggmann and colleagues [1] present a landmark multinational and interprofessional research agenda for ICUAW.This initiative brings together 51 experts -including clinicians, scientists, and individuals with lived experienceto define ten priority questions that will shape the next decade of research. From pathophysiology to personalisationBuilding on the 2017 ICM research roadmap by Latronico et al. [2], this new agenda decisively broadens the scope.The focus shifts from describing mechanisms to harnessing them for individualized therapy.The authors highlight that early muscle loss-averaging 15% in the first ICU week-reflects complex interactions between systemic inflammation, bioenergetic failure, and impaired protein synthesis rather than immobility alone.Accordingly, future research must integrate mechanistic biomarkers such as urea-to-creatinine ratio, creatinine production rate, and urinary titin into clinical studies, linking biology to the bedside.