Effects of Neuromuscular Electrical Stimulation of the Quadriceps and Diaphragm in Critically Ill Patients: A Pilot Study

Abstract

Background Deep and respiratory muscle disorders are commonly observed in critically ill patients. Neuromuscular electrical stimulation (NMES) is an alternative to mobilize and to exercise that does not require active patient participation and can be used on bedridden patients. Objective Evaluate the effectiveness of the NMES therapy in quadriceps versus diaphragm subjects in mechanical ventilation (MV). Methods Sixty-seven subjects in MV were included, divided into 3 groups: (a) control group (CG, n=26), (b) stimulation of quadriceps (quadriceps group–QG, n=24), and (c) stimulation of diaphragm (diaphragm group–DG, n=17). The QG and DG patients received consecutive daily electrical stimulation sessions at specific points from the first day of randomization until ICU discharge. Respiratory and peripheral muscle strength, MV time, length of hospitalization, and functional independence score (the Functional Status Score-ICU) were recorded. Results There were studied n=24 (QG), n=17 (DG), and n=26 (CG) patients. Peripheral muscle strength improved significantly in the QG (p=0.030). Functional independence at ICU discharge was significantly better in QG (p=0.013), and the QG presented a better Barthel Index compared to DG and CG (p=0.0049) and also presented better FSS compared to CG (p=0.001). Conclusions Electrical stimulation of quadriceps had best outcomes for peripheral muscle strength compared with controls or electrical stimulation of diaphragm among mechanically ventilated critically ill subjects and promoted functional independence and decreased length of hospitalization.

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.…”

“… Study(Author/Year) Country Number of cases (E/C) Participants Intervention measures Frequency/intensity Measurement E C Leite et al. [ 24 ] 2018 Indonesia 41/26 ≥18 years of age, and ≥24 h of MV duration NMES Routine nursing care 45 min per day on the quadriceps; Synchronized impulse at a frequency of 30 Hz. MRC score, MV duration, ICU length of stay, total length of stay, MIP, FSS-ICU, ADL, GCS score.…”

“… Study Random allocation Allocation concealment Blind method Whether to describe loss of follow-up Selective results report Other migration Quality grade Leite et al. [ 24 ] Unclear High High Yes Low Low B Koutsioumpa et al. [ 13 ] Low High High Yes Low Low B Patsaki et al.…”

“…Seven articles [ 13 , 24 , 25 , 27 , 29 , 32 , 33 ] included in this study used the MRC score to diagnose the incidence of ICU-AW; 5 articles [ 13 , 24 , 25 , 27 , 32 ] used an MRC score of <48 to diagnose ICU-AW and provided the mean and standard deviation in the results, one article [ 29 ] provided the median and 25%–75% quartiles, and the remaining article [ 33 ] only recorded the number of patients with grades 0–5. Therefore, to preserve the integrity of the data, only the indicators obtained by the same evaluation method were included and consolidated.…”

The effects of transcutaneous electrostimulation in patients in the intensive care unit

“…Após a extração dos dados, eles foram agrupados em tabelas para permitir a especificação dos itens para facilitar a análise comparativa dos estudos, favorecendo a identificação da variabilidade entre eles. , com duração de 45 minutos16 . nutos, utilizando uma frequência de 50 Hz , largura de pulso 500US, não descrevendo o tempo on e off utilizado, enquanto o grupo controle (n = 42) recebeu apenas fisioterapia convencional.…”