Neuromuscular electrical stimulation in the intensive care unit prevents muscle atrophy in critically ill older patients: A retrospective cohort study

Abstract

Critically ill patients in the intensive care unit (ICU) develop muscle atrophy and decreased physical function. Though neuromuscular electrical stimulation (NMES) therapy has been shown to be effective in preventing this, but its effect on older patients is unknown.To examine the course of critically ill older patients treated with NMES in the ICU and to define the impact of its use.A retrospective cohort study was conducted using older ICU patients (≥65 years) categorized into a control group (n = 20) and an NMES group (n = 22). For subgroup analysis, each group was further classified into pre-old age (65-74 years) and old age (≥75 years).The control group showed significant decrease in muscle thickness during ICU and hospital stay. The NMES group showed lower reduction in muscle thickness and showed decrease in muscle echo intensity during hospital stay, compared to the control group. NMES inhibited decrease in muscle thickness in the pre-old age group versus the old age group. The decreasing effect of NMES on echo intensity during hospital stay manifested only in the pre-old age group. We did not find much difference in physical functioning between the NMES and control groups.Lower limb muscle atrophy reduces in critically ill older patients (≥65 years) with NMES and is pronounced in patients aged < 75 years. The impact of NMES on the physical functioning of older patients in ICU needs to be further investigated.

Kinesiophysiological analysis associated with changes in subjective intensities in belt electrode-skeletal muscle electrical stimulation: a prospective exploratory study

“…A notable aspect of this study is that the subjective intensity generated >3 METs at strong intensity or maximum tolerated intensity. This indicates that kinesiophysiologically plausible stimulation intensities can be achieved using patient-dependent subjective intensity, as carried out in previous studies 8 , 9 , 10 , 11 , 12 , 13 ) . These results suggest that treatment with B-SES may provide a viable alternative to conventional therapeutic exercise.…”

“…Several studies in healthy individuals have reported the effects of B-SES on muscle strength, muscle flexibility, and cardiorespiratory fitness 7 , 16 ) . In a clinical setting such as a hospital, it is starting to be applied to patients where aggressive therapeutic exercise is difficult 8 , 9 , 10 , 11 , 12 , 13 ) . However, the stimulation intensity in B-SES has mostly relied on the patient’s subjective intensity choice.…”

“…However, according to a recent study, light-intensity physical activity has also been shown to have a positive effect on health outcomes in a dose-dependent manner 21 , 22 ) . Treatment with B-SES is often reported to last approximately 20 minutes or more per day 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ) , but duration and frequency have not been standardized. Determining FITT (F, frequency; I, intensity; T, time or duration, T; type of exercise) is important in rehabilitation prescriptions 23 ) .…”

“…Compared with conventional EMS, the electrode area and the skin contact area are larger, which distributes the current density, enabling significant reduction of pain and discomfort during stimulation, and induces whole muscle contraction in the lower limbs 6 , 7 ) . Treatment with B-SES has shown particularly positive results in patients who find it difficult to undertake therapeutic exercise in a clinical setting such as a hospital 8 , 9 , 10 , 11 , 12 , 13 ) . In these studies, the B-SES stimulation intensity was set incrementally dependent on the patient’s subjectivity.…”

Outcomes Addressed by Whole-Body Electromyostimulation and Belt Electrode-Skeletal Muscle Electrical Stimulation Trials in Middle Aged to Older Adults – an Evidence Map

“…Maximum strength changes of the lower extremities [12,16,22,23,29,32,37,40,41,45,46,51,53,57,61,62,67,71,75,82,83,85,86], trunk [12,37,41,51,55,71,93] and upper extremities/hand [12,16,22,25,27,41,45,49,57,[61][62][63]69,71,76,85] 4 were determined by many studies. About two thirds of the studies/projects applied isometric tests; functional tests were performed by seven studies and eight studies used isokinetic devices for strength assessments [16,…”