Effect of Electrical Muscle Stimulation on Upper and Lower Limb Muscles in Critically Ill Patients: A Two-Center Randomized Controlled Trial

Abstract

Objectives: Electrical muscle stimulation is widely used to enhance lower limb mobilization. Although upper limb muscle atrophy is common in critically ill patients, electrical muscle stimulation application for the upper limbs has been rarely reported. The purpose of this study was to investigate whether electrical muscle stimulation prevents upper and lower limb muscle atrophy and improves physical function. Design: Randomized controlled trial. Setting: Two-center, mixed medical/surgical ICU. Patients: Adult patients who were expected to be mechanically ventilated for greater than 48 hours and stay in the ICU for greater than 5 days. Interventions: Forty-two patients were randomly assigned to the electrical muscle stimulation (n = 17) or control group (n = 19). Measurements and Main Results: Primary outcomes were change in muscle thickness and cross-sectional area of the biceps brachii and rectus femoris from day 1 to 5. Secondary outcomes included occurrence of ICU-acquired weakness, ICU mobility scale, length of hospitalization, and amino acid levels. The change in biceps brachii muscle thickness was –1.9% versus –11.2% in the electrical muscle stimulation and control (p = 0.007) groups, and the change in cross-sectional area was –2.7% versus –10.0% (p = 0.03). The change in rectus femoris muscle thickness was –0.9% versus –14.7% (p = 0.003) and cross-sectional area was –1.7% versus –10.4% (p = 0.04). No significant difference was found in ICU-acquired weakness (13% vs 40%; p = 0.20) and ICU mobility scale (3 vs 2; p = 0.42) between the groups. The length of hospitalization was shorter in the electrical muscle stimulation group (23 d [19–34 d] vs 40 d [26–64 d]) (p = 0.04). On day 3, the change in the branched-chain amino acid level was lower in the electrical muscle stimulation group (40.5% vs 71.5%; p = 0.04). Conclusions: In critically ill patients, electrical muscle stimulation prevented upper and lower limb muscle atrophy and attenuated proteolysis and decreased the length of hospitalization.

Effect of neuromuscular electrical stimulation on the recovery of people with COVID-19 admitted to the intensive care unit: A narrative review

“…The data from these studies and longer-term treatment, for example, up to 9 weeks ( 29 ) suggest that NMES can be used in the ICU to slow down muscle wasting, but it is necessary for participants to then use home-based NMES to maintain and strengthen muscles post-ICU. Interestingly, recent research by Nakashini et al ( 30 ) suggests that identifying the motor-point to elicit the strongest contraction, as well as increasing the number of contractions in a session, may maintain muscle strength more effectively. Researchers included a 30-min daily session (180 contractions) for 5 days to the NMES group, while the control had usual care.…”

“…Iwatsu et al ( 77 ) provided evidence assuring the safety of stimulation in the ICU. Furthermore, none of the other published clinical trials that used non-invasive electrical stimulation in the ICU reported interference with the ICU equipment ( 27 , 28 , 30 , 33 , 34 , 78 ). Interference with pacemakers and implantable cardioverter defibrillators appears to depend on the proximity of the electrodes to the implanted device; lower limb stimulation, in particular, appears safe in this group, but clinicians must be aware of, and monitor for, such an interaction ( 79 ), especially if stimulation of respiratory muscles is indicated.…”

Urinary Titin N-Fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome

“…Rehabilitation has been proven to be effective in preventing muscle atrophy and physical dysfunction [86,87]. Nakanishi et al reported that electrical muscle stimulation was effective in preventing muscle breakdown [88]. In the study, blood branched-chain amino acid, which is an important muscle component, was investigated, and the amino acid level was lower in the patients who received the electrical muscle stimulation intervention (40.5% (−7.4%-75.3%) vs. 71.5% (38.8%-116.9%)), suggesting a decrease in muscle breakdown.…”

Urinary Titin N-fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome

“…Rehabilitation has proven to be effective in preventing muscle atrophy and physical dysfunction [67,68]. Nakanishi et al reported that electrical muscle stimulation was effective in preventing muscle breakdown [69]. In the study, blood branchedchain amino acid, which is an important muscle component, was investigated, and the amino acid level was lower in the patients who received the electrical muscle stimulation intervention (40.5% [−7.4% to 75.3%] vs. 71.5% [38.8% to 116.9%]), suggesting a decrease in muscle breakdown.…”