Early Neuromuscular Electrical Stimulation in Addition to Early Mobilization Improves Functional Status and Decreases Hospitalization Days of Critically Ill Patients

by Campos, Débora R.; Bueno, Thatiana B. C.; Anjos, Jackeline S. G. G.; Zoppi, Daniel; Dantas, Bruno G.; Gosselink, Rik; Guirro, Rinaldo R. J.; Borges, Marcos C

Critical Care Medicine: April 12, 2022 - Volume - Issue - 10

Objectives: To evaluate the impact of the additional use of early neuromuscular electrical stimulation (NMES) on an early mobilization (EM) protocol.

Design: Randomized controlled trial. Setting: ICU of the Clinical Hospital of Ribeirão Preto, University of São Paulo, Brazil.

Patients: One hundred and thirty-nine consecutive mechanically ventilated patients were included in the first 48 hours of ICU admission. Interventions: The patients were divided into two groups: EM and EM+NMES. Both groups received EM daily. In the EM+NMES group, patients additionally received NMES 5 days a week, for 60 minutes, starting in the first 48 hours of ICU admission until ICU discharge.

Measurements and Main Results: Functional status, muscle strength, ICU and hospital length of stay (LOS), frequency of delirium, days on mechanical ventilation, mortality, and quality of life were assessed. Patients in the EM+NMES group presented a significant higher score of functional status measured by the Functional Status Score for the ICU scale when compared with the EM group in the first day awake: 22 (15–26) versus 12 (8–22) (p = 0.019); at ICU discharge: 28 (21–33) versus 18 (11–26) (p = 0.004); and hospital discharge: 33 (27–35) versus 25 (17–33) (p = 0.014), respectively. They also had better functional status measured by the Physical Function Test in the ICU scale, took less days to stand up during the ICU stay, and had a significant shorter hospital LOS, lower frequency of ICU-acquired weakness, and better global muscle strength.

Conclusions: The additional application of early NMES promoted better functional status outcomes on the first day awake and at ICU and hospital discharge. The patients in the EM+NMES group also took fewer days to stand up and had shorter hospital LOS, lower frequency of ICU-acquired weakness, and better muscle strength. Future studies are still necessary to clarify the effects of therapies associated with EM, especially to assess long-term outcomes.