Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review

Abstract

BackgroundNeuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic review was to evaluate the effectiveness of NMES for preventing skeletal-muscle weakness and wasting in critically ill patients, in comparison with usual care.MethodsWe searched PubMed, CENTRAL, CINAHL, Web of Science, and PEDro to identify randomized controlled trials exploring the effect of NMES in critically ill patients, which had a well-defined NMES protocol, provided outcomes related to skeletal-muscle strength and/or mass, and for which full text was available. Two independent reviewers extracted data on muscle-related outcomes (strength and mass), and participant and intervention characteristics, and assessed the methodological quality of the studies. Owing to the lack of means and standard deviations (SDs) in some studies, as well as the lack of baseline measurements in two studies, it was impossible to conduct a full meta-analysis. When means and SDs were provided, the effect sizes of individual outcomes were calculated, and otherwise, a qualitative analysis was performed.ResultsThe search yielded 8 eligible studies involving 172 patients. The methodological quality of the studies was moderate to high. Five studies reported an increase in strength or better preservation of strength with NMES, with one study having a large effect size. Two studies found better preservation of muscle mass with NMES, with small to moderate effect sizes, while no significant benefits were found in two other studies.ConclusionsNMES added to usual care proved to be more effective than usual care alone for preventing skeletal-muscle weakness in critically ill patients. However, there is inconclusive evidence for its benefit in prevention of muscle wasting.

Use of neuromuscular electrical stimulation to preserve the thickness of abdominal and chest muscles of critically ill patients: A randomized clinical trial

“…However, few studies have been conducted in ICUs, especially involving trunk muscles, such as abdominal and chest muscles. Studies on NMES have suggested that this technique is useful in medical practice, with the purpose of preventing or decreasing loss of muscle mass and peripheral muscle atrophy in this population (23,24). We could not find reports of its benefits in core muscle groups, such as the ones investigated in our study, as we know that loss of muscle mass does not affect only peripheral muscles.…”

Early mobilization in the critical care unit: A review of adult and pediatric literature

“…Diagnosis of ICU-AW in children is hindered by the lack of a suitable diagnostic tool [23]. The Medical Research Council (MRC) grading tool is unreliable and unfeasible in children, and handheld dynamometry is best used as a simple screening tool for ICU-AW in alert patients [23,66]. Dynamometry and MRC scoring are volitional measures that are confounded by the need for patient effort, alertness, and motivation.…”

“…Dynamometry and MRC scoring are volitional measures that are confounded by the need for patient effort, alertness, and motivation. The aforementioned variables are affected by patient's levels of consciousness and by the levels of sedative and analgesic medications [10,66,67]. As neither dynamometry or MRC scoring is capable of identifying the early onset of ICU-AW, there is a need for an objective measure of evoked muscle force, which would be more suitable for use in pediatric populations [66,67].…”

Introducing simplified electrophysiological test of peripheral nerves and muscles in the ICU: choosing wisely

“…Importantly, the deconditioned patients were clinically indistinguishable from those with altered electrophysiology. Thus, EPS, along with other patient characteristics such as increasing age, greater burden of comorbid illness, and prolonged ICU length of stay, may serve to identify different phenotypes of patients with ICUAW, and thereby improve prognostication as well as guide individualized treatments [10] [5,11], it is more likely to be effective in younger patients with ICUAW and normal EPS than in the elderly with associated chronic conditions and electrically unexcitable muscle.…”