Therapeutic Potential of Electromyostimulation (EMS) in Critically Ill Patients—A Systematic Review

Abstract

Ample evidence exists that intensive care unit (ICU) treatment and invasive ventilation induce a transient or permanent decline in muscle mass and function. The functional deficit is often called ICU-acquired weakness with critical illness polyneuropathy (CIP) and/or myopathy (CIM) being the major underlying causes. Histopathological studies in ICU patients indicate loss of myosin filaments, muscle fiber necrosis, atrophy of both muscle fiber types as well as axonal degeneration. Besides medical prevention of risk factors such as sepsis, hyperglycemia and pneumonia, treatment is limited to early passive and active mobilization and one third of CIP/CIM patients discharged from ICU never regain their pre-hospitalization constitution. Electromyostimulation [EMS, also termed neuromuscular electrical stimulation (NMES)] is known to improve strength and function of healthy and already atrophied muscle, and may increase muscle blood flow and induce angiogenesis as well as beneficial systemic vascular adaptations. This systematic review aimed to investigate evidence from randomized controlled trails (RCTs) on the efficacy of EMS to improve the condition of critically ill patients treated on ICU. A systematic search of the literature was conducted using PubMed (Medline), CENTRAL (including Embase and CINAHL), and Google Scholar. Out of 1,917 identified records, 26 articles (1,312 patients) fulfilled the eligibility criteria of investigating at least one functional measure including muscle function, functional independence, or weaning outcomes using a RCT design in critically ill ICU patients. A qualitative approach was used, and results were structured by 1) stimulated muscles/muscle area (quadriceps muscle only; two to four leg muscle groups; legs and arms; chest and abdomen) and 2) treatment duration (≤10 days, >10 days). Stimulation parameters (impulse frequency, pulse width, intensity, duty cycle) were also collected and the net EMS treatment time was calculated. A high grade of heterogeneity between studies was detected with major cofactors being the analyzed patient group and selected outcome variable. The overall efficacy of EMS was inconclusive and neither treatment duration, stimulation site or net EMS treatment time had clear effects on study outcomes. Based on our findings, we provide practical recommendations and suggestions for future studies investigating the therapeutic efficacy of EMS in critically ill patients.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021262287].

Safety and efficacy of electrical stimulation for lower-extremity muscle weakness in intensive care unit 2019 Novel Coronavirus patients: A phase I double-blinded randomized controlled trial

“…Comparison at 9 days showed there was significantly higher muscle endurance in patients undergoing active stimulation compared to those that did not. We believe these findings are due to the prompt activation of muscle fibers which may deaccelerate the rapid atrophy, myofilament damage, protein synthesis, and wasting found within the first week of ICU length of stay ( 43 ). E-Stim induces non-selective recruitment and activation of both type I and type II muscle fibers which conform the GNM ( 44 ), ultimately enhancing strength and cross-sectional area ( 45 ) in immobilized patients ( 46 ).…”

Characteristics of the Cerebrospinal Fluid in Septic Patients with Critical Illness Polyneuropathy - A Retrospective Cohort Study

“…Some researchers proposed that CIP is a multiple lesion of peripheral nerve axons [21]. Histological examinations confirmed axonal degeneration of non-distal sensorimotor fibers, which can further decrease neuromuscular stimulation and result in muscle atrophy [22][23][24]. Schmidt et al found that the Medical Research Council (MRC) score can be used to identify patients with CIP during intensive care bedside assessment [5].…”

Case report of belt electrode-skeletal muscle electrical stimulation for acute heart failure with severe obesity: a novel therapeutic option for acute phase rehabilitation

“…Consequently, the settings of the B-SES were upregulated to a stimulus of 20 min at a frequency of 20 Hz, in the daytime, and a stimulus of 30 min in the evening at a frequency of 4 Hz. For high intensity protocol, we have adopted a frequency of 20 Hz, as per the effective frequency proposed in the past report (10).…”

“…B-SES can induce high-intensity muscle contraction throughout both lower limbs owing to its large electrode area and offers a higher exercise potential than conventional NMES. The weekly duration of treatment has been reported to be associated with effectiveness, with a recommendation of at least 25 min per day (10). In consideration of the low cardiac function we have combined both low intensity and high intensity protocol, extending the daily duration to a maximum of 50 min.…”