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.

Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis

 Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis

 

by Dominik Menges, Bianca Seiler, Yuki Tomonaga, Matthias Schwenkglenks, Milo A. Puhan and Henock G. Yebyo 

 

Critical Care volume 25, Article number: 16 (2021)

 

Background

This systematic review and meta-analysis aimed to determine the effectiveness of systematic early mobilization in improving muscle strength and physical function in mechanically ventilated intensive care unit (ICU) patients.

Methods

We conducted a two-stage systematic literature search in MEDLINE, EMBASE and the Cochrane Library until January 2019 for randomized controlled trials (RCTs) examining the effects of early mobilization initiated within 7 days after ICU admission compared with late mobilization, standard early mobilization or no mobilization. Priority outcomes were Medical Research Council Sum Score (MRC-SS), incidence of ICU-acquired weakness (ICUAW), 6-min walk test (6MWT), proportion of patients reaching independence, time needed until walking, SF-36 Physical Function Domain Score (PFS) and SF-36 Physical Health Component Score (PCS). Meta-analysis was conducted where sufficient comparable evidence was available. We evaluated the certainty of evidence according to the GRADE approach.

Results

We identified 12 eligible RCTs contributing data from 1304 participants. Two RCTs were categorized as comparing systematic early with late mobilization, nine with standard early mobilization and one with no mobilization. We found evidence for a benefit of systematic early mobilization compared to late mobilization for SF-36 PFS (MD 12.3; 95% CI 3.9–20.8) and PCS (MD 3.4; 95% CI 0.01–6.8), as well as on the proportion of patients reaching independence and the time needed to walking, but not for incidence of ICUAW (RR 0.62; 95% CI 0.38–1.03) or MRC-SS. For systematic early compared to standard early mobilization, we found no statistically significant benefit on MRC-SS (MD 5.8; 95% CI − 1.4 to 13.0), incidence of ICUAW (RR 0.90; 95% CI 0.63–1.27), SF-36 PFS (MD 8.1; 95% CI − 15.3 to 31.4) or PCS (MD − 2.4; 95% CI − 6.1 to 1.3) or other priority outcomes except for change in 6MWT from baseline. Generally, effects appeared stronger for systematic early compared to late mobilization than to standard early mobilization. We judged the certainty of evidence for all outcomes as very low to low.

Conclusion

The evidence regarding a benefit of systematic early mobilization remained inconclusive. However, our findings indicate that the larger the difference in the timing between the intervention and the comparator, the more likely an RCT is to find a benefit for early mobilization.

Overcoming nursing barriers to intensive care unit early mobilisation: A quality improvement project

Overcoming nursing barriers to intensive care unit early mobilisation: A quality improvement project
Hunter, Oluwatobi O. et al.
Intensive and Critical Care Nursing, Article in Press

Technological advancements in critical care have increased intensive care unit (ICU) survivorship. Survivors may experience functional impairment 5–15 years after critical illness, resulting in decreased quality of life and increased use and cost of healthcare services (Herridge et al., 2011; Yosef-Brauner et al., 2015). These long-term post-ICU physical impairments are due in part to intensive care unit acquired weakness (ICUAW). ICUAW is a syndrome of multifactorial etiology that results in impaired ventilator weaning and prolonged intensive care unit length of stay (LOS) (Desai et al., 2011; Lipshutz and Gropper, 2013).