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

Abstract

Objective: To evaluate and compare the effects of neuromuscular electrical stimulation combined with conventional physical therapy on muscle thickness in critically ill patients. Design: Double-blind, randomized controlled trial. Patients: Twenty-five patients participated in the study. Methods: Patients on mechanical ventilation for 24-48 h were randomized to an intervention group (neuromuscular electrical stimulation + conventional physical therapy) or a conventional group (sham neuromuscular electrical stimulation + conventional physical therapy). Primary outcome was thickness of the rectus abdominis and chest muscles, determined on cross-sectional ultrasound images before and after the intervention. Results: Eleven patients were included in the intervention group and 14 in the conventional group. After neuromuscular electrical stimulation, rectus abdominis muscle thickness and chest muscle thickness were preserved in the intervention group, whereas there was a significant reduction in thickness in the conventional group, with a significant difference between groups. There was a significant difference between groups in length of stay in the intensive care unit, with shorter length of stay in the intervention group. Conclusion: There was no change in rectus abdominis and chest muscle thickness in the intervention group. A significant decrease was found in these measures in the conventional group.

Breath-synchronized electrical stimulation of the expiratory muscles in mechanically ventilated patients: a randomized controlled feasibility study and pooled analysis

“…For the pooled data, we observed a between-group difference in total abdominal expiratory muscle thickness changes on day 3, favoring the active group. Although effects were small, our observations are in line with Dall’Acqua et al [ 28 ], showing that FES of the rectus abdominis muscle (note that this muscle is to a limited extent involved in expiration [ 1 ], therefore not specifically targeted in our study) of ICU patients resulted in muscle mass preservation in the active group, while thickness decreased in the sham group. However, we found no between-group differences on day 5, likely resulting from insufficient sample size and observer variability (see ‘ Strengths and limitations ’ section).…”

Intervention effect of neuromuscular electrical stimulation on ICU acquired weakness: A meta-analysis

“…A total of 693 related studies were identified in the preliminary search, and 11 RCTs [ 13 , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ], including 576 patients, were finally included. A flow chart detailing the article screening process is shown in Fig.…”

“… Acqua et al. [ 26 ] 2017 Brazil 19/19 ≥18 years of age, ≥24 h of MV duration and ≥15 days of total length of stay. NMES False NMES + routine care 30 min per day and 1 min was added every 2 days of administration; 50 Hz frequency, pulse duration 300 ms, rise time 1sec, stimulus time (on) 3sec, deck time 1sec, and relaxation time (off) 10 sec.…”

“…[ 25 ] Low Low Low Yes Low Low A Acqua et al. [ 26 ] Low Low Low Yes Low Low A Kho et al. [ 27 ] Unclear Low Low Yes Low Low B Vivodtzev et al.…”

“…Six studies [ 13 , 24 , 26 , 27 , 32 , 33 ] evaluated the effect of NMES on the MV time of ICU patients. The outcome indicators were reported with different units: 4 studies used d/day, and 2 studies used h/hour.…”