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.
Highlights
Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness
Owing to the heterogeneity of the critically ill patient group and of the NMES procedures implemented in intensive care unit (ICU) [18,26,27,28], the effectiveness of this rehabilitation procedure for ICU-acquired weakness (ICUAW) prevention remains to be clearly proven
After 113 duplicates were removed and 348 records were screened, only ten full-text articles could be assessed for eligibility (336 records were excluded because they did not meet all the required inclusion criteria, and two further studies were excluded because they were conference proceeding abstracts and the full text was not available [39,40])
Summary
Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. A large majority of patients admitted to the intensive care unit (ICU) after the very acute phase of a critical illness exhibit major defects in skeletal-muscle strength (weakness) and mass (wasting) [1,2,3] This so-called ICU-acquired weakness (ICUAW) is generally defined as a bilateral deficit of muscle strength in all limbs [4], which is accompanied by a profound loss of muscle mass (as high as 5% per day during the first week of ICU stay [5,6]), and is associated with delayed weaning from mechanical ventilation [7], protracted and costly stays in ICU and hospital stay (the average daily ICU cost being approximately €1,000 [8]), and high mortality rates [9,10]. Owing to the heterogeneity of the critically ill patient group and of the NMES procedures implemented in ICUs [18,26,27,28], the effectiveness of this rehabilitation procedure for ICUAW prevention remains to be clearly proven
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