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Early neuromuscular electrical stimulation in addition to early mobilization improves functional status and decreases hospitalization days of critically ill patients
Campos DR, Bueno TBC, Anjos J, Zoppi D, Dantas BG, Gosselink R, Guirro RRJ, Borges MC
Critical Care Medicine 2022 Jul;50(7):1116-1126
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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 Ribeirao Preto, University of Sao 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 plus NMES. Both groups received EM daily. In the EM plus 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 plus 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 to 26) versus 12 (8 to 22) (p = 0.019); at ICU discharge: 28 (21 to 33) versus 18 (11 to 26) (p = 0.004); and hospital discharge: 33 (27 to 35) versus 25 (17 to 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 plus 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.

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