Respiratory muscle dysfunction in older critically ill patients: Implications for rehabilitation
Issued Date
2026-01-01
Resource Type
eISSN
23525568
Scopus ID
2-s2.0-105034571104
Pubmed ID
41175935
Journal Title
Anaesthesia Critical Care and Pain Medicine
Rights Holder(s)
SCOPUS
Bibliographic Citation
Anaesthesia Critical Care and Pain Medicine (2026)
Suggested Citation
Arriagada R., San Martín C., Martí J.D., Rocco P.R.M., Gosselink R., Schultz M.J., Battaglini D. Respiratory muscle dysfunction in older critically ill patients: Implications for rehabilitation. Anaesthesia Critical Care and Pain Medicine (2026). doi:10.1016/j.accpm.2025.101657 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116130
Title
Respiratory muscle dysfunction in older critically ill patients: Implications for rehabilitation
Author's Affiliation
Universidade Federal do Rio de Janeiro
Università degli Studi di Genova
Amsterdam UMC - University of Amsterdam
Medizinische Universität Wien
Stellenbosch University
Hospital Clínic de Barcelona
IRCCS San Martino Polyclinic Hospital
Nuffield Department of Medicine
Universitat Ramon Llull
Universidad San Sebastián
Mahidol Oxford Tropical Medicine Research Unit
Departement Revalidatiewetenschappen
Hospital Las Higueras
Università degli Studi di Genova
Amsterdam UMC - University of Amsterdam
Medizinische Universität Wien
Stellenbosch University
Hospital Clínic de Barcelona
IRCCS San Martino Polyclinic Hospital
Nuffield Department of Medicine
Universitat Ramon Llull
Universidad San Sebastián
Mahidol Oxford Tropical Medicine Research Unit
Departement Revalidatiewetenschappen
Hospital Las Higueras
Corresponding Author(s)
Other Contributor(s)
Abstract
Older patients represent a rapidly expanding and clinically vulnerable population within intensive care units (ICUs), often presenting with complex, multifactorial health challenges. The physiological changes associated with aging, when compounded by critical illness, result in significant dysfunction of both peripheral and respiratory musculature. These alterations are further aggravated by clinical frailty, a multidimensional syndrome now recognized as a key determinant of adverse outcomes in critically ill patients.Respiratory muscle dysfunction in this population contributes to prolonged weaning from mechanical ventilation, diminished physical resilience, and delayed functional recovery. Converging factors such as age-related sarcopenia, diaphragmatic atrophy, impaired neuromuscular transmission, and systemic inflammation impair respiratory mechanics and ventilatory efficiency. The interplay between frailty and respiratory muscle weakness highlights the urgent need for early identification and targeted interventions.This review synthesizes current evidence on the pathophysiological changes affecting respiratory and peripheral muscles in older ICU patients and explores their impact on clinical outcomes. It emphasizes the essential role of clinicians in developing and implementing early, individualized rehabilitation strategies tailored to the needs of this population. Multidisciplinary approaches aimed at improving respiratory muscle performance, accelerating functional recovery, and reducing the burden of ICU-acquired weakness and ventilator dependence are also discussed.Recognizing the unique physiological and functional needs of older critically ill patients is imperative for optimizing rehabilitation trajectories and improving both short- and long-term outcomes in this increasingly prevalent patient group.