{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:14:44Z","timestamp":1790723684097,"version":"4.1.0"},"reference-count":111,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Intensive Care Unit Acquired Weakness (ICUAW) is a highly prevalent neuromuscular complication affecting around 40% of critically ill patients, rising to over 80% in high-risk cohorts. It is independently associated with prolonged mechanical ventilation, increased intensive care unit (ICU) and hospital length of stay, elevated mortality (in-hospital, 1-year, and 5-year), higher healthcare costs, and long-term functional impairment. ICUAW is clinically defined by symmetric flaccid tetraparesis, frequently involving respiratory muscles, and exhibits significant pathobiological heterogeneity. Further subclassification is based on neurotopographic patterns: Critical Illness Polyneuropathy (CIP), Myopathy (CIM), and Polyneuromyopathy (CIPNM). Diagnosis typically relies on the Medical Research Council (MRC) Sum Score, with a threshold of &lt;48 indicating clinically relevant weakness. While adjunct modalities such as electromyography\/nerve conduction studies support assessment, their utility may be limited by patient cooperation and availability. Preventive strategies center on modifiable metabolic factors. Caloric and protein deficits exacerbate catabolism, while overfeeding\u2014linked to anabolic resistance and stress hyperglycemia\u2014also impairs recovery. To date, pharmacologic interventions remain inconclusive. However, early mobilization and neuromuscular electrical stimulation are promising non-pharmacologic strategies. The multifactorial and heterogeneous pathophysiology of ICUAW highlights the need for a biologically refined definition that can guide future targeted therapeutic interventions. Comprehensive multimodal strategies, together with structured long-term follow-up in Post-Intensive Care Syndrome (PICS) clinics, are essential for improving outcomes in this prevalent complication of critical care.<\/jats:p>","DOI":"10.3390\/nu18050820","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T08:51:33Z","timestamp":1772614293000},"page":"820","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Intensive Care Unit Acquired Weakness as a Modifiable Organ Dysfunction? A Narrative Review of Evolving Diagnostic and Therapeutic Concepts"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9553-9911","authenticated-orcid":false,"given":"Moritz L.","family":"Schmidbauer","sequence":"first","affiliation":[{"name":"Department of Neurology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0417-2267","authenticated-orcid":false,"given":"Konstantinos","family":"Dimitriadis","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1164\/rccm.201411-2011ST","article-title":"An Official American Thoracic Society Clinical Practice Guideline: The Diagnosis of Intensive Care Unit\u2013Acquired Weakness in Adults","volume":"190","author":"Fan","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S0300-2977(00)00019-X","article-title":"Incidence and Onset of Critical Illness Polyneuropathy in Patients with Septic Shock","volume":"56","author":"Tepper","year":"2000","journal-title":"Neth. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1007\/s001340050669","article-title":"Patterns of Neurophysiological Abnormality in Prolonged Critical Illness","volume":"24","author":"Coakley","year":"1998","journal-title":"Intensive Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1186\/s13054-025-05462-z","article-title":"Muscle Weakness after Critical Illness: Unravelling Biological Mechanisms and Clinical Hurdles","volume":"29","author":"Pierre","year":"2025","journal-title":"Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2138","DOI":"10.1007\/s00134-015-3979-7","article-title":"Predictive Value for Weakness and 1-Year Mortality of Screening Electrophysiology Tests in the ICU","volume":"41","author":"Hermans","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1007\/s00134-020-05927-5","article-title":"Five-Year Impact of ICU-Acquired Neuromuscular Complications: A Prospective, Observational Study","volume":"46","author":"Meersseman","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1164\/rccm.201312-2257OC","article-title":"Acute Outcomes and 1-Year Mortality of Intensive Care Unit-Acquired Weakness: A Cohort Study and Propensity-Matched Analysis","volume":"190","author":"Hermans","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1097\/CCM.0000000000002763","article-title":"Outcomes of ICU Patients with a Discharge Diagnosis of Critical Illness Polyneuromyopathy: A Propensity-Matched Analysis","volume":"45","author":"Kelmenson","year":"2017","journal-title":"Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1186\/s13054-023-04569-5","article-title":"Guideline on Multimodal Rehabilitation for Patients with Post-Intensive Care Syndrome","volume":"27","author":"Renner","year":"2023","journal-title":"Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"361","DOI":"10.4266\/acc.001450","article-title":"Intensive Care Unit-Acquired Muscle Atrophy and Weakness in Critical Illness: A Review of Long-Term Recovery Strategies","volume":"40","author":"Nakanishi","year":"2025","journal-title":"Acute Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jointm.2023.07.002","article-title":"Intensive Care Unit-Acquired Weakness: Recent Insights","volume":"4","author":"Chen","year":"2024","journal-title":"J. Intensive Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Petrucci, M., Gemma, S., Carbone, L., Piccioni, A., Della Polla, D.A., Simeoni, B., Franceschi, F., and Covino, M. (2025). ICU-Acquired Weakness: From Pathophysiology to Management in Critical Care. Emerg. Care Med., 2.","DOI":"10.3390\/ecm2010004"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00134-020-05944-4","article-title":"ICU-Acquired Weakness","volume":"46","author":"Vanhorebeek","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1152\/physrev.00028.2014","article-title":"The Sick and the Weak: Neuropathies\/Myopathies in the Critically Ill","volume":"95","author":"Friedrich","year":"2015","journal-title":"Physiol. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1007\/s00134-017-4757-5","article-title":"The ICM Research Agenda on Intensive Care Unit-Acquired Weakness","volume":"43","author":"Latronico","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_16","first-page":"121","article-title":"Critical Illness-Associated Limb and Diaphragmatic Weakness","volume":"30","author":"Latronico","year":"2024","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/S1474-4422(11)70178-8","article-title":"Critical Illness Polyneuropathy and Myopathy: A Major Cause of Muscle Weakness and Paralysis","volume":"10","author":"Latronico","year":"2011","journal-title":"Lancet Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1164\/rccm.201607-1516CI","article-title":"On the Neuroendocrinopathy of Critical Illness. Perspectives for Feeding and Novel Treatments","volume":"194","year":"2016","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1164\/rccm.201512-2344OC","article-title":"Mechanisms of Chronic Muscle Wasting and Dysfunction after an Intensive Care Unit Stay. A Pilot Study","volume":"194","author":"Hussain","year":"2016","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/BCR.0000000000000280","article-title":"Proteasome Inhibition After Burn Injury","volume":"37","author":"Vana","year":"2016","journal-title":"J. Burn Care Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1097\/SHK.0000000000001860","article-title":"Neuregulin-1\u03b2 Alleviates Sepsis-Induced Skeletal Muscle Atrophy by Inhibiting Autophagy via AKT\/MTOR Signaling Pathway in Rats","volume":"57","author":"Yin","year":"2022","journal-title":"Shock"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Rivera, J.C., Abrigo, J., Tacchi, F., Simon, F., Brandan, E., Santos, R.A., Bader, M., Chiong, M., and Cabello-Verrugio, C. (2020). Angiotensin-(1-7) Prevents Lipopolysaccharide-Induced Autophagy via the Mas Receptor in Skeletal Muscle. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21249344"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/S2213-2600(13)70183-8","article-title":"Effect of Tolerating Macronutrient Deficit on the Development of Intensive-Care Unit Acquired Weakness: A Subanalysis of the EPaNIC Trial","volume":"1","author":"Hermans","year":"2013","journal-title":"Lancet Respir. Med."},{"key":"ref_24","first-page":"306","article-title":"Nutrition and Autophagy Deficiency in Critical Illness","volume":"29","author":"Vanhorebeek","year":"2023","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/S2213-2600(23)00092-9","article-title":"Low versus Standard Calorie and Protein Feeding in Ventilated Adults with Shock: A Randomised, Controlled, Multicentre, Open-Label, Parallel-Group Trial (NUTRIREA-3)","volume":"11","author":"Reignier","year":"2023","journal-title":"Lancet Respir. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S0140-6736(17)32146-3","article-title":"Enteral versus Parenteral Early Nutrition in Ventilated Adults with Shock: A Randomised, Controlled, Multicentre, Open-Label, Parallel-Group Study (NUTRIREA-2)","volume":"391","author":"Reignier","year":"2018","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1056\/NEJMoa1102662","article-title":"Early versus Late Parenteral Nutrition in Critically Ill Adults","volume":"365","author":"Casaer","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s13054-016-1298-1","article-title":"Enteral versus Parenteral Nutrition in Critically Ill Patients: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"20","author":"Elke","year":"2016","journal-title":"Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1186\/s13054-024-05067-y","article-title":"Accelerometer-Derived Movement Features as Predictive Biomarkers for Muscle Atrophy in Neurocritical Care: A Prospective Cohort Study","volume":"28","author":"Schmidbauer","year":"2024","journal-title":"Crit. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s40560-019-0413-1","article-title":"Early versus Delayed Mobilization for In-Hospital Mortality and Health-Related Quality of Life among Critically Ill Patients: A Systematic Review and Meta-Analysis","volume":"7","author":"Okada","year":"2019","journal-title":"J. Intensive Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e49920","DOI":"10.7554\/eLife.49920","article-title":"Chronic Muscle Weakness and Mitochondrial Dysfunction in the Absence of Sustained Atrophy in a Preclinical Sepsis Model","volume":"8","author":"Owen","year":"2019","journal-title":"eLife"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1002\/jcsm.12903","article-title":"MicroRNA Regulatory Networks Associated with Abnormal Muscle Repair in Survivors of Critical Illness","volume":"13","author":"Walsh","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0140-6736(02)09459-X","article-title":"Association between Mitochondrial Dysfunction and Severity and Outcome of Septic Shock","volume":"360","author":"Brealey","year":"2002","journal-title":"Lancet"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s13613-023-01236-4","article-title":"Activation of Senescence in Critically Ill Patients: Mechanisms, Consequences and Therapeutic Opportunities","volume":"14","author":"Rioseras","year":"2024","journal-title":"Ann. Intensive Care"},{"key":"ref_35","first-page":"e1164","article-title":"Persistent Fatigue, Weakness, and Aberrant Muscle Mitochondria in Survivors of Critical COVID-19","volume":"6","author":"Mayer","year":"2024","journal-title":"Crit. Care Explor."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1097\/CCM.0b013e31823295e6","article-title":"Early Type II Fiber Atrophy in Intensive Care Unit Patients with Nonexcitable Muscle Membrane","volume":"40","author":"Bierbrauer","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1186\/s13054-016-1500-5","article-title":"Near-Infrared Spectroscopy for Assessing Tissue Oxygenation and Microvascular Reactivity in Critically Ill Patients: A Prospective Observational Study","volume":"20","author":"Donati","year":"2016","journal-title":"Crit. Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1097\/CCM.0b013e3182742e8b","article-title":"Microcirculatory Alterations in Patients With Severe Sepsis","volume":"41","author":"Donadello","year":"2013","journal-title":"Crit. Care Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Mendelson, A.A., Erickson, D., and Villar, R. (2023). The Role of the Microcirculation and Integrative Cardiovascular Physiology in the Pathogenesis of ICU-Acquired Weakness. Front. Physiol., 14.","DOI":"10.3389\/fphys.2023.1170429"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"29334","DOI":"10.1038\/srep29334","article-title":"Transcriptomic Analysis Reveals Abnormal Muscle Repair and Remodeling in Survivors of Critical Illness with Sustained Weakness","volume":"6","author":"Walsh","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1172\/JCI36570","article-title":"Inactivation of Sodium Channels Underlies Reversible Neuropathy during Critical Illness in Rats","volume":"119","author":"Novak","year":"2009","journal-title":"J. Clin. Investig."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1152\/jn.00936.2012","article-title":"Reduced Motoneuron Excitability in a Rat Model of Sepsis","volume":"109","author":"Nardelli","year":"2013","journal-title":"J. Neurophysiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1093\/brain\/awl191","article-title":"Nerve Excitability Changes in Critical Illness Polyneuropathy","volume":"129","author":"Lin","year":"2006","journal-title":"Brain"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1186\/s13054-023-04676-3","article-title":"Critical Illness Weakness, Polyneuropathy and Myopathy: Diagnosis, Treatment, and Long-Term Outcomes","volume":"27","author":"Latronico","year":"2023","journal-title":"Crit. Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2859","DOI":"10.1001\/jama.288.22.2859","article-title":"Paresis Acquired in the Intensive Care Unit: A Prospective Multicenter Study","volume":"288","author":"Sharshar","year":"2002","journal-title":"JAMA"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1097\/CCM.0000000000000030","article-title":"Assessment of Limb Muscle Strength in Critically Ill Patients","volume":"42","author":"Vanpee","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s13054-015-0780-5","article-title":"A New Two-Tier Strength Assessment Approach to the Diagnosis of Weakness in Intensive Care: An Observational Study","volume":"19","author":"Parry","year":"2015","journal-title":"Crit. Care"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1164\/rccm.200712-1829OC","article-title":"Acquired Weakness, Handgrip Strength, and Mortality in Critically III Patients","volume":"178","author":"Ali","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jcrc.2012.03.001","article-title":"Muscle Strength Assessment in Critically Ill Patients with Handheld Dynamometry: An Investigation of Reliability, Minimal Detectable Change, and Time to Peak Force Generation","volume":"28","author":"Baldwin","year":"2013","journal-title":"J. Crit. Care"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/S0022-510X(98)00164-6","article-title":"Clinical and Electrophysiological Findings in Critical Illness Polyneuropathy","volume":"159","author":"Zifko","year":"1998","journal-title":"J. Neurol. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"127","DOI":"10.12688\/f1000research.3933.1","article-title":"Validation of the Peroneal Nerve Test to Diagnose Critical Illness Polyneuropathy and Myopathy in the Intensive Care Unit: The Multicentre Italian CRIMYNE-2 Diagnostic Accuracy Study","volume":"3","author":"Latronico","year":"2014","journal-title":"F1000Research"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"R11","DOI":"10.1186\/cc5671","article-title":"Simplified Electrophysiological Evaluation of Peripheral Nerves in Critically Ill Patients: The Italian Multi-Centre CRIMYNE Study","volume":"11","author":"Latronico","year":"2007","journal-title":"Crit. Care"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Maskos, A., Schmidbauer, M.L., Kunst, S., Rehms, R., Putz, T., R\u00f6mer, S., Iankova, V., and Dimitriadis, K. (2022). Diagnostic Utility of Temporal Muscle Thickness as a Monitoring Tool for Muscle Wasting in Neurocritical Care. Nutrients, 14.","DOI":"10.3390\/nu14214498"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.jcrc.2018.05.017","article-title":"Assessing Skeletal Muscle Dysfunction in Sepsis Utilizing Muscle Ultrasound in Search for Pathways to Improve ICU Survivor\u2019s Functional Outcomes","volume":"47","author":"Dhar","year":"2018","journal-title":"J. Crit. Care"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1002\/mus.21285","article-title":"Quantitative Gray-scale Analysis in Skeletal Muscle Ultrasound: A Comparison Study of Two Ultrasound Devices","volume":"39","author":"Pillen","year":"2009","journal-title":"Muscle Nerve"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Yik, V., Kok, S.S.X., Chean, E., Lam, Y.E., Chua, W.T., Tan, W.J., Foo, F.J., Ng, J.L., Su, S.S., and Chong, C.X.Z. (2024). Diagnosing Sarcopenia with AI-Aided Ultrasound (DINOSAUR)\u2014A Pilot Study. Nutrients, 16.","DOI":"10.3390\/nu16162768"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"696","DOI":"10.2340\/16501977-2368","article-title":"Critical Evaluation of Muscle Mass Loss as a Prognostic Marker of Morbidity in Critically Ill Patients and Methods for Its Determination","volume":"50","author":"Joskova","year":"2018","journal-title":"J. Rehabil. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1007\/s00134-024-07458-9","article-title":"Nutrition in the Intensive Care Unit: From the Acute Phase to Beyond","volume":"50","author":"Gunst","year":"2024","journal-title":"Intensive Care Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e429","DOI":"10.1097\/CCM.0000000000006537","article-title":"Toward Precision in Nutrition Therapy","volume":"53","author":"Stoppe","year":"2024","journal-title":"Crit. Care Med."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Gehri, L., Schmidbauer, M.L., Putz, T., Ratkovic, L., Maskos, A., Zeisberger, C., Zibold, J., and Dimitriadis, K. (2024). Clinical Medicine Survey on Nutrition in Neurological Intensive Care Units (SONNIC)\u2014A Cross-Sectional Survey among German-Speaking Neurointensivists on Medical Nutritional Therapy. J. Clin. Med., 13.","DOI":"10.3390\/jcm13020447"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1001\/jama.2012.137","article-title":"Initial Trophic vs. Full Enteral Feeding in Patients with Acute Lung Injury: The EDEN Randomized Trial","volume":"307","author":"Rice","year":"2012","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2398","DOI":"10.1056\/NEJMoa1502826","article-title":"Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults","volume":"372","author":"Arabi","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1056\/NEJMoa1811687","article-title":"Energy-Dense versus Routine Enteral Nutrition in the Critically Ill","volume":"379","author":"Chapman","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1056\/NEJMoa1409860","article-title":"Trial of the Route of Early Nutritional Support in Critically Ill Adults","volume":"371","author":"Harvey","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1056\/NEJMoa1514762","article-title":"Early versus Late Parenteral Nutrition in Critically Ill Children","volume":"374","author":"Fivez","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1097\/CCM.0000000000001652","article-title":"Pharmacological Therapy for the Prevention and Treatment of Weakness after Critical Illness: A Systematic Review","volume":"44","author":"Shepherd","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1056\/NEJMoa011300","article-title":"Intensive Insulin Therapy in Critically Ill Patients","volume":"345","author":"Wouters","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1016\/j.clnu.2023.07.011","article-title":"ESPEN Practical and Partially Revised Guideline: Clinical Nutrition in the Intensive Care Unit","volume":"42","author":"Singer","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1007\/s00134-016-4665-0","article-title":"Early Enteral Nutrition in Critically Ill Patients: ESICM Clinical Practice Guidelines","volume":"43","author":"Starkopf","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.clnesp.2019.05.002","article-title":"Clinical Nutrition in Critical Care Medicine\u2014Guideline of the German Society for Nutritional Medicine (DGEM)","volume":"33","author":"Elke","year":"2019","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1016\/j.clnu.2018.04.020","article-title":"Predictive Equations versus Measured Energy Expenditure by Indirect Calorimetry: A Retrospective Validation","volume":"38","author":"Zusman","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1007\/s00134-009-1567-4","article-title":"The Relationship between Nutritional Intake and Clinical Outcomes in Critically Ill Patients: Results of an International Multicenter Observational Study","volume":"35","author":"Alberda","year":"2009","journal-title":"Intensive Care Med."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Lew, C., Wong, G., Cheung, K., Chua, A., Chong, M., and Miller, M. (2017). Association between Malnutrition and 28-Day Mortality and Intensive Care Length-of-Stay in the Critically Ill: A Prospective Cohort Study. Nutrients, 10.","DOI":"10.3390\/nu10010010"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.clnu.2005.03.006","article-title":"Negative Impact of Hypocaloric Feeding and Energy Balance on Clinical Outcome in ICU Patients","volume":"24","author":"Villet","year":"2005","journal-title":"Clin. Nutr."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/S0140-6736(24)01304-7","article-title":"Effect of High versus Standard Protein Provision on Functional Recovery in People with Critical Illness (PRECISe): An Investigator-Initiated, Double-Blinded, Multicentre, Parallel-Group, Randomised Controlled Trial in Belgium and the Netherlands","volume":"404","author":"Bels","year":"2024","journal-title":"Lancet"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/S0140-6736(22)02469-2","article-title":"The Effect of Higher Protein Dosing in Critically Ill Patients with High Nutritional Risk (EFFORT Protein): An International, Multicentre, Pragmatic, Registry-Based Randomised Trial","volume":"401","author":"Heyland","year":"2023","journal-title":"Lancet"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1001\/jama.2025.9110","article-title":"Augmented Enteral Protein During Critical Illness","volume":"334","author":"Summers","year":"2025","journal-title":"JAMA"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13054-023-04783-1","article-title":"The Effects of Higher versus Lower Protein Delivery in Critically Ill Patients: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis","volume":"28","author":"Lee","year":"2024","journal-title":"Crit. Care"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1056\/NEJMoa2304855","article-title":"Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU","volume":"389","author":"Gunst","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S0140-6736(09)60044-1","article-title":"Intensive Insulin Therapy for Patients in Paediatric Intensive Care: A Prospective, Randomised Controlled Study","volume":"373","author":"Vlasselaers","year":"2009","journal-title":"Lancet"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1056\/NEJMoa052521","article-title":"Intensive Insulin Therapy in the Medical ICU","volume":"354","author":"Wilmer","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"S230","DOI":"10.2337\/dc23-S014","article-title":"14. Children and Adolescents: Standards of Care in Diabetes-2023","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"3251","DOI":"10.1097\/CCM.0b013e3182653269","article-title":"Guidelines for the Use of an Insulin Infusion for the Management of Hyperglycemia in Critically Ill Patients","volume":"40","author":"Jacobi","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","article-title":"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021","volume":"49","author":"Evans","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1164\/rccm.200605-665OC","article-title":"Impact of Intensive Insulin Therapy on Neuromuscular Complications and Ventilator Dependency in the Medical Intensive Care Unit","volume":"175","author":"Hermans","year":"2007","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1097\/CCM.0000000000003262","article-title":"Corticosteroids in Sepsis: An Updated Systematic Review and Meta-Analysis","volume":"46","author":"Rochwerg","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/s13054-018-2111-0","article-title":"Corticosteroid Use and Intensive Care Unit-Acquired Weakness: A Systematic Review and Meta-Analysis","volume":"22","author":"Yang","year":"2018","journal-title":"Crit. Care"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/ane.12964","article-title":"Risk Factors for Intensive Care Unit-Acquired Weakness: A Systematic Review and Meta-Analysis","volume":"138","author":"Yang","year":"2018","journal-title":"Acta Neurol. Scand."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Wieske, L., Witteveen, E., Verhamme, C., Dettling-Ihnenfeldt, D.S., van der Schaaf, M., Schultz, M.J., van Schaik, I.N., and Horn, J. (2014). Early Prediction of Intensive Care Unit\u2013Acquired Weakness Using Easily Available Parameters: A Prospective Observational Study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0111259"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s00134-015-3731-3","article-title":"Is Gentamicin Affecting the Neuromuscular System of Critically Ill Patients?","volume":"41","author":"Wieske","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.chest.2018.07.016","article-title":"Impact of Vasoactive Medications on ICU-Acquired Weakness in Mechanically Ventilated Patients","volume":"154","author":"Wolfe","year":"2018","journal-title":"Chest"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1164\/rccm.201107-1320OE","article-title":"Neuromuscular Blockade and Skeletal Muscle Weakness in Critically Ill Patients","volume":"185","author":"Puthucheary","year":"2012","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1056\/NEJMoa1005372","article-title":"Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome","volume":"363","author":"Papazian","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"National Heart, Lung, and Blood Institute PETAL Clinical Trials Network (2019). Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome. N. Engl. J. Med., 380, 1997\u20132008.","DOI":"10.1056\/NEJMoa1901686"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1097\/CCM.0000000000005941","article-title":"Effect of Neuromuscular Electrical Stimulation in Patients With Critical Illness: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"51","author":"Nakanishi","year":"2023","journal-title":"Crit. Care Med."},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"(2022). The TEAM Study Investigators; The ANZICS Clinical Trials Group. Early Active Mobilization during Mechanical Ventilation in the ICU. N. Engl. J. Med., 387, 1747\u20131758.","DOI":"10.1056\/NEJMoa2209083"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"e019998","DOI":"10.1136\/bmjopen-2017-019998","article-title":"Early Rehabilitation to Prevent Postintensive Care Syndrome in Patients with Critical Illness: A Systematic Review and Meta-Analysis","volume":"8","author":"Fuke","year":"2018","journal-title":"BMJ Open"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jcrc.2020.11.018","article-title":"Early Neuromuscular Electrical Stimulation Reduces the Loss of Muscle Mass in Critically Ill Patients\u2014A within Subject Randomized Controlled Trial","volume":"62","author":"Segers","year":"2021","journal-title":"J. Crit. Care"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.jcrc.2016.09.012","article-title":"Safety and Feasibility of a Neuromuscular Electrical Stimulation Chronaxie-Based Protocol in Critical Ill Patients: A Prospective Observational Study","volume":"37","author":"Silva","year":"2017","journal-title":"J. Crit. Care"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1016\/S0140-6736(16)31637-3","article-title":"Early, Goal-Directed Mobilisation in the Surgical Intensive Care Unit: A Randomised Controlled Trial","volume":"388","author":"Schaller","year":"2016","journal-title":"Lancet"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/S2213-2600(22)00489-1","article-title":"Effect of Early Mobilisation on Long-Term Cognitive Impairment in Critical Illness in the USA: A Randomised Controlled Trial","volume":"11","author":"Patel","year":"2023","journal-title":"Lancet Respir. Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1016\/S0140-6736(09)60658-9","article-title":"Early Physical and Occupational Therapy in Mechanically Ventilated, Critically Ill Patients: A Randomised Controlled Trial","volume":"373","author":"Schweickert","year":"2009","journal-title":"Lancet"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1164\/rccm.201505-1039OC","article-title":"A Randomized Trial of an Intensive Physical Therapy Program for Patients with Acute Respiratory Failure","volume":"193","author":"Moss","year":"2016","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1136\/thoraxjnl-2016-209858","article-title":"Intensive versus Standard Physical Rehabilitation Therapy in the Critically Ill (EPICC): A Multicentre, Parallel-Group, Randomised Controlled Trial","volume":"73","author":"Wright","year":"2018","journal-title":"Thorax"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"e299","DOI":"10.1097\/CCM.0000000000006259","article-title":"Should New Data on Rehabilitation Interventions in Critically Ill Patients Change Clinical Practice? Updated Meta-Analysis of Randomized Controlled Trials","volume":"52","author":"Waldauf","year":"2024","journal-title":"Crit. Care Med."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"103607","DOI":"10.1016\/j.iccn.2023.103607","article-title":"Optimal Timing for Early Mobilization Initiatives in Intensive Care Unit Patients: A Systematic Review and Network Meta-Analysis","volume":"82","year":"2024","journal-title":"Intensive Crit. Care Nurs."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1097\/CCM.0b013e318180b90e","article-title":"Early Intensive Care Unit Mobility Therapy in the Treatment of Acute Respiratory Failure","volume":"36","author":"Morris","year":"2008","journal-title":"Crit. Care Med."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/CCM.0000000000004181","article-title":"Impact of a Progressive Mobility Program on the Functional Status, Respiratory, and Muscular Systems of ICU Patients: A Randomized and Controlled Trial","volume":"48","author":"Schujmann","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"EVIDoa2400137","DOI":"10.1056\/EVIDoa2400137","article-title":"Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients","volume":"3","author":"Kho","year":"2024","journal-title":"NEJM Evid."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.arr.2018.07.003","article-title":"Physical Strategies to Prevent Disuse-Induced Functional Decline in the Elderly","volume":"47","author":"Valenzuela","year":"2018","journal-title":"Ageing Res. Rev."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1513\/AnnalsATS.201611-843SR","article-title":"Safety of Patient Mobilization and Rehabilitation in the Intensive Care Unit. Systematic Review with Meta-Analysis","volume":"14","author":"Nydahl","year":"2017","journal-title":"Ann. Am. Thorac. 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