Effectiveness of physical exercise and neuromuscular electrical stimulation interventions for preventing and treating intensive care unit-acquired weakness: A systematic review of randomized controlled trials

García-Pérez-de-Sevilla, Guillermo; Pinto, Beatriz Sánchez-Pinto

doi:10.1016/j.iccn.2022.103333

Cited by 10 publications

(9 citation statements)

References 31 publications

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“…Decreased muscle strength appears to start in the early days of ICU admission, and patients may experience increasing sarcopenia (loss of muscle mass) of ~2% per day. The incidence of ICU sarcopenia can affect 70% of hospitalized patients, depending on the patient's age and comorbidity [3], while the prevalence of ICUAW can reach 43% [5]. Therefore, early and noninvasive therapeutic interventions that can reduce or prevent muscle weakness, such as PBMT, are important for these patients [36], as well as for wider public health interests.…”

Section: Discussionmentioning

confidence: 99%

“…As one limitation to our study, we did not perform any post‐discharge follow up, so we do not know if the PBMT group had a better overall recovery than the sham group after their ICU discharge. The literature shows that ICUAW is associated with lower MRC, functional ability and quality of life in the post‐discharge period, and with higher mortality risks [5], so future studies should include a longer follow‐up period to test whether PBMT has any long‐term benefits in this population. In addition, other limitations of the present study were not assessing skin phototypes, or tone, and the physical activity level of the patients before their hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…This generalized muscle weakness, which is unrelated to the patient's acute disease or its treatment, is called “Intensive Care Unit Acquired Weakness” (ICUAW). ICUAW can affect both the peripheral and respiratory muscles and leads to important reductions in the functional capacity of ICU patients and is associated with a higher risk of death [1, 5]. Early and noninvasive assessment of these patients, such as the use of handgrip strength evaluation [6], muscle strength by Medical Research Council score (MRC) [7], Intensive Care Unit Mobility Scale (IMS) [8, 9], and quantification of length of stay in the ICU is essential to monitor these patients and for clinical decision making [4].…”

Section: Introductionmentioning

confidence: 99%

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Photobiomodulation therapy (red/NIR LEDs) reduced the length of stay in intensive care unit and improved muscle function: A randomized, triple‐blind, and sham‐controlled trial

Neto,

Espósito,

da Rocha

et al. 2024

Journal of Biophotonics

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ContextPhotobiomodulation therapy (PBMT) has been widely used to improve strength, fatigue resistance and increase muscle mass in healthy individuals. These effects could help critically ill patients admitted to intensive care units (ICUs) who show reduced mobility and muscle strength. ICU‐acquired weakness lessens overall health and increases the patient's length of stay in the ICU.ObjectiveThis study evaluated the effects of PBMT using low intensity light‐emitting diodes (LEDs) on the mobility and muscle strength (functional capacity) and length of stay of patients admitted to hospital ICU.MethodsThis randomized, triple‐blind, sham‐controlled trial was conducted in a hospital ICU. Sixty patients were randomly assigned to two equal groups: (a) PBMT and (b) Sham. PBMT was applied daily to patients until their discharge from the ICU, using a flexible neoprene array of 264 LEDs (120 at 635 nm, 1.2 mW each; 144 at 880 nm, 15 mW each) for 90s (207.36 Joules) at each site. Ten sites were located bilaterally on the thighs, legs, arms, and forearms ventrally and dorsally, 15 min totaling 2,073.6 Joules per session. Outcomes were length of stay (in h) until discharge from the ICU, muscle strength by the Medical Research Council (MRC) score and handgrip dynamometry (HGD), patient mobility by Intensive Care Unit Mobility Scale (IMS) and the Simplified Acute Physiology Score 3 (SAPS 3) for predicting mortality of patients admitted to the ICU.ResultsPBMT reduced the average length of stay in the ICU by ~30% (p = 0.028); increased mobility (IMS: 255% vs. 110% p = 0.007), increased muscle strength (MRC: 12% vs. −9% p = 0.001) and HGD (34% vs. −13% p < 0.001), and the SAPS3 score was similar (p > 0.05).ConclusionThe results suggest that daily PBMT can reduce the length of stay of ICU patients and increase muscle strength and mobility.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Photobiomodulation therapy (red/NIR LEDs) reduced the length of stay in intensive care unit and improved muscle function: A randomized, triple‐blind, and sham‐controlled trial

Neto,

Espósito,

da Rocha

et al. 2024

Journal of Biophotonics

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“…80 In addition to adequate nutritional management, physical exercise and neuromuscular electrical stimulation may be used to prevent excessive muscle mass loss and ought to be specifically considered in ACLF patients. 85…”

Section: General Management 1 Nutritional Supportmentioning

confidence: 99%

Critical Care Management of Acute-on-Chronic Liver Failure: Certainties and Unknowns

et al. 2023

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Intensive care unit (ICU) admission is frequently required in patients with decompensated cirrhosis for organ support. This entity, known as acute-on-chronic liver failure (ACLF), is associated with high short-term mortality. ICU management of ACLF is complex, as these patients are prone to develop new organ failures and infectious or bleeding complications. Poor nutritional status, lack of effective liver support systems, and shortage of liver donors are also factors that contribute to increase their mortality. ICU therapy parallels that applied in the general ICU population in some complications but has differential characteristics in others. This review describes the current knowledge on critical care management of patients with ACLF including organ support, prognostic assessment, early liver transplantation, and futility rules. Certainties and knowledge gaps in this area are also discussed.

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“…A meta-analysis conducted by Liu et al 22 indicated that three studies examined the effects of early NMES use in critically ill patients 18,27,28 but the evidence was ambiguous due to the studies' diversity and inconsistent findings. Furthermore, the most recent systematic review of randomized controlled trials by García-Pérez-de-Sevilla and Sánchez-Pinto Pinto 29 found that physical activity and NMES prevent excessive loss of muscle in patients admitted to the ICU and increase muscle strength in patients discharged with ICU-AW. However, it is important to note that this study does include limitations pertaining to inconsistencies that might potentially affect the validity of their risk of bias assessment.…”

Section: What This Paper Addsmentioning

confidence: 99%

Effect of neuromuscular electrical stimulation and early physical activity on ICU‐acquired weakness in mechanically ventilated patients: A randomized controlled trial

Othman,

Elbiaa,

Mansour

et al. 2023

Nursing in Critical Care

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BackgroundIntensive care unit‐acquired weakness (ICU‐AW) is common in critically ill patients and increases the duration of mechanical ventilation (MV) and weaning time. Early mobilization, range of motion (ROM) exercises, and neuromuscular electrical stimulation (NMES) can prevent ICU‐AW by maintaining muscle mass. However, studies highlighting the effects of combining NMES with early physical activity in ICU patients are limited.AimTo evaluate the effect of NMES and early physical activity on ICU‐AW in mechanically ventilated patients.DesignA single‐blinded randomized controlled trial was conducted in Alexandria, Egypt.MethodPatients were randomly assigned to one of four groups: NMES, ROM, combined therapy (ROM + NMES), or conventional care (control group). The Medical Research Council (MRC) scale was used to assess the ICU‐AW for the study patients over a 7‐day period. The duration of the patient's MV and ICU stays were recorded.ResultsOf the 180 patients who were assessed for eligibility, 124 were randomly assigned to one of four groups: 32 patients in ROM exercises, 30 in NMES, 31 in combined therapy (ROM + NMES), and 31 in the control group. On day 7, ROM + NMES and NMES groups showed higher MRC scores than ROM and control groups (50.37 ± 2.34, 49.77 ± 2.19, 44.97 ± 3.61, and 41.10 ± 3.84, respectively). ANOVA test results indicated significant differences (p < .001) across the four groups. ICU‐AW occurred in 0% of the ROM + NMES group, 60% of the ROM group, 13% of the NMES group, and 100% of the control group (p < .001). The MV duration (in days) in the ROM + NMES group was shorter (12.80 ± 3.800) than in the ROM, NMES, or control groups (21.80 ± 4.460, 18.73 ± 4.748, and 20.70 ± 3.932, respectively). ICU‐LOS was shorter in the ROM + NMES group (17.43 ± 3.17 days) compared with the ROM group (22.53 ± 4.51 days), the NMES group (21.10 ± 5.0 days), and the control group (21.50 ± 4.42 days) with significant differences (p < .001) between the four groups.ConclusionDaily sessions of NMES and early physical activity were well tolerated, preserved muscle strength, prevented ICU‐AW, and decreased the duration of the MV and ICU stay.Relevance to Clinical PracticeThe findings of this study support the use of NMES and early physical exercises by critical care nurses as part of routine care for critically ill patients.

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Effectiveness of physical exercise and neuromuscular electrical stimulation interventions for preventing and treating intensive care unit-acquired weakness: A systematic review of randomized controlled trials

Cited by 10 publications

References 31 publications

Photobiomodulation therapy (red/NIR LEDs) reduced the length of stay in intensive care unit and improved muscle function: A randomized, triple‐blind, and sham‐controlled trial

Photobiomodulation therapy (red/NIR LEDs) reduced the length of stay in intensive care unit and improved muscle function: A randomized, triple‐blind, and sham‐controlled trial

Critical Care Management of Acute-on-Chronic Liver Failure: Certainties and Unknowns

Effect of neuromuscular electrical stimulation and early physical activity on ICU‐acquired weakness in mechanically ventilated patients: A randomized controlled trial

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