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.
