INTRODUCTION: Intensive care unit-acquired weakness (ICUAW) is one of the most common neuromuscular impairments featuring symmetric and generalized weakness, typically occurs in critically ill patients or patients with sepsis. Mechanistically, ICUAW shares overlapping immunological networks with respiratory viruses. While accumulating evidence supports an association between Guillain-Barré syndrome (GBS) and respiratory viruses, the causal relationship between ICUAW and these pathogens has not been sufficiently emphasized. AREAS COVERED: This review summarizes current knowledge on the classification, diagnosis, and management of ICUAW, with a special focus on its potential association with respiratory viruses. Relevant literature was identified through searches of PubMed, Web of Science, Cochrane Library, and Google Scholar, focusing on English-language studies published between January 2019 and March 2026. The review addresses differential diagnostic challenges, potential pathogenic mechanism, therapeutic interventions, and preventive strategies. EXPERT OPINION: Emerging evidence suggests that respiratory virus may exacerbate ICUAW, highlighting timely interventions combing biomarkers such as Interleukin (IL)-6 and Growth Differentiation Factor (GDF)-15 as promising therapeutic targets. Standardization of diagnostic criteria, refinement of animal models, and individualized rehabilitation strategies are appealed. Future studies on ICUAW should concentrate on early assessment of muscle strength, evaluation of nutritional therapy efficacy and avoidance of potential comorbidities.
Zheng et al. (Fri,) studied this question.