Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review

Nicola A Maffiuletti, Marc Roig, Eleftherios Karatzanos, Serafim Nanas, Nicola A Maffiuletti, Marc Roig, Eleftherios Karatzanos, Serafim Nanas

Abstract

Background: Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic review was to evaluate the effectiveness of NMES for preventing skeletal-muscle weakness and wasting in critically ill patients, in comparison with usual care.

Methods: We searched PubMed, CENTRAL, CINAHL, Web of Science, and PEDro to identify randomized controlled trials exploring the effect of NMES in critically ill patients, which had a well-defined NMES protocol, provided outcomes related to skeletal-muscle strength and/or mass, and for which full text was available. Two independent reviewers extracted data on muscle-related outcomes (strength and mass), and participant and intervention characteristics, and assessed the methodological quality of the studies. Owing to the lack of means and standard deviations (SDs) in some studies, as well as the lack of baseline measurements in two studies, it was impossible to conduct a full meta-analysis. When means and SDs were provided, the effect sizes of individual outcomes were calculated, and otherwise, a qualitative analysis was performed.

Results: The search yielded 8 eligible studies involving 172 patients. The methodological quality of the studies was moderate to high. Five studies reported an increase in strength or better preservation of strength with NMES, with one study having a large effect size. Two studies found better preservation of muscle mass with NMES, with small to moderate effect sizes, while no significant benefits were found in two other studies.

Conclusions: NMES added to usual care proved to be more effective than usual care alone for preventing skeletal-muscle weakness in critically ill patients. However, there is inconclusive evidence for its benefit in prevention of muscle wasting.

Figures

Figure 1
Figure 1
Flow diagram of search strategy.

References

    1. Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011;10:931–941. doi: 10.1016/S1474-4422(11)70178-8.
    1. Puthucheary Z, Montgomery H, Moxham J, Harridge S, Hart N. Structure to function: muscle failure in critically ill patients. J Physiol. 2010;588:4641–4648. doi: 10.1113/jphysiol.2010.197632.
    1. de Jonghe B, Lacherade JC, Sharshar T, Outin H. Intensive care unit-acquired weakness: risk factors and prevention. Crit Care Med. 2009;37:S309–315.
    1. De Jonghe B, Sharshar T, Hopkinson N, Outin H. Paresis following mechanical ventilation. Curr Opin Crit Care. 2004;10:47–52. doi: 10.1097/00075198-200402000-00008.
    1. Griffiths RD, Palmer TE, Helliwell T, MacLennan P, MacMillan RR. Effect of passive stretching on the wasting of muscle in the critically ill. Nutrition. 1995;11:428–432.
    1. Reid CL, Campbell IT, Little RA. Muscle wasting and energy balance in critical illness. Clin Nutr. 2004;23:273–280. doi: 10.1016/S0261-5614(03)00129-8.
    1. De Jonghe B, Bastuji-Garin S, Durand MC, Malissin I, Rodrigues P, Cerf C, Outin H, Sharshar T. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med. 2007;35:2007–2015. doi: 10.1097/01.ccm.0000281450.01881.d8.
    1. Edbrooke DL, Minelli C, Mills GH, Iapichino G, Pezzi A, Corbella D, Jacobs P, Lippert A, Wiis J, Pesenti A. Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis. Crit Care. 2011;15:R56. doi: 10.1186/cc10029.
    1. Leijten FS, Harinck-de Weerd JE, Poortvliet DC, de Weerd AW. The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation. JAMA. 1995;274:1221–1225. doi: 10.1001/jama.1995.03530150045032.
    1. Nanas S, Kritikos K, Angelopoulos E, Siafaka A, Tsikriki S, Poriazi M, Kanaloupiti D, Kontogeorgi M, Pratikaki M, Zervakis D. Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit. Acta Neurol Scand. 2008;118:175–181. doi: 10.1111/j.1600-0404.2008.00996.x.
    1. Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–1304. doi: 10.1056/NEJMoa1011802.
    1. Fletcher SN, Kennedy DD, Ghosh IR, Misra VP, Kiff K, Coakley JH, Hinds CJ. Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med. 2003;31:1012–1016. doi: 10.1097/01.CCM.0000053651.38421.D9.
    1. Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, Hermans G, Decramer M, Gosselink R. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009;37:2499–2505. doi: 10.1097/CCM.0b013e3181a38937.
    1. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–1882. doi: 10.1016/S0140-6736(09)60658-9.
    1. Thomsen GE, Snow GL, Rodriguez L, Hopkins RO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36:1119–1124. doi: 10.1097/CCM.0b013e318168f986.
    1. Puthucheary Z, Harridge S, Hart N. Skeletal muscle dysfunction in critical care: Wasting, weakness, and rehabilitation strategies. Crit Care Med. 2010;38:S676–S682.
    1. Needham DM, Truong AD, Fan E. Technology to enhance physical rehabilitation of critically ill patients. Crit Care Med. 2009;37:S436–441.
    1. Truong AD, Fan E, Brower RG, Needham DM. Bench-to-bedside review: mobilizing patients in the intensive care unit–from pathophysiology to clinical trials. Crit Care. 2009;13:216. doi: 10.1186/cc7885.
    1. Stevens RD, Hart N, de Jonghe B, Sharshar T. Weakness in the ICU: a call to action. Crit Care. 2009;13:R161. doi: 10.1186/cc8123.
    1. Lee CM, Fan E. ICU-acquired weakness: what is preventing its rehabilitation in critically ill patients? BMC Med. 2012;10:115. doi: 10.1186/1741-7015-10-115.
    1. Maffiuletti NA. Physiological and methodological considerations for the use of neuromuscular electrical stimulation. Eur J Appl Physiol. 2010;110:223–234. doi: 10.1007/s00421-010-1502-y.
    1. Roig M, Reid WD. Electrical stimulation and peripheral muscle function in COPD: a systematic review. Respir Med. 2009;103:485–495. doi: 10.1016/j.rmed.2008.11.008.
    1. Gibson JN, Smith K, Rennie MJ. Prevention of disuse muscle atrophy by means of electrical stimulation: maintenance of protein synthesis. Lancet. 1988;2:767–770.
    1. Gerovasili V, Tripodaki E, Karatzanos E, Pitsolis T, Markaki V, Zervakis D, Routsi C, Roussos C, Nanas S. Short-term systemic effect of electrical muscle stimulation in critically iII patients. Chest. 2009;136:1249–1256. doi: 10.1378/chest.08-2888.
    1. Gerovasili V, Stefanidis K, Vitzilaios K, Karatzanos E, Politis P, Koroneos A, Chatzimichail A, Routsi C, Roussos C, Nanas S. Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study. Crit Care. 2009;13:R161. doi: 10.1186/cc8123.
    1. Laghi F, Jubran A. Treating the septic muscle with electrical stimulations. Crit Care Med. 2011;39:585–586. doi: 10.1097/CCM.0b013e31820e2f6f.
    1. Kho ME, Truong AD, Brower RG, Palmer JB, Fan E, Zanni JM, Ciesla ND, Feldman DR, Korupolu R, Needham DM. Neuromuscular electrical stimulation for intensive care unit-acquired weakness: protocol and methodological implications for a randomized, sham-controlled, phase II trial. Phys Ther. 2012;92:1564–1579. doi: 10.2522/ptj.20110437.
    1. Maddocks M, Gao W, Higginson IJ, Wilcock A. Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev. 2011;11 CD009419.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. doi: 10.1371/journal.pmed.1000097.
    1. de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55:129–133. doi: 10.1016/S0004-9514(09)70043-1.
    1. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83:713–721.
    1. Roig M, Shadgan B, Reid WD. Eccentric exercise in patients with chronic health conditions: a systematic review. Physiother Can. 2008;60:146–160. doi: 10.3138/physio.60.2.146.
    1. van Tulder M, Furlan A, Bombardier C, Bouter L. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine (Phila Pa 1976) 2003;28:1290–1299.
    1. Field A. Discovering statistics using SPSS. 2. London: SAGE; 2005. p. 156.
    1. Karatzanos E, Gerovasili V, Zervakis D, Tripodaki ES, Apostolou K, Vasileiadis I, Papadopoulos E, Mitsiou G, Tsimpouki D, Routsi C. Electrical muscle stimulation: an effective form of exercise and early mobilization to preserve muscle strength in critically ill patients. Crit Care Res Pract. 2012;2012:432752.
    1. Routsi C, Gerovasili V, Vasileiadis I, Karatzanos E, Pitsolis T, Tripodaki E, Markaki V, Zervakis D, Nanas S. Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial. Crit Care. 2010;14:R74. doi: 10.1186/cc8987.
    1. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13. doi: 10.1186/1471-2288-5-13.
    1. Cohen J. Statistical methods for meta-analysis. San Diego: Academic Press; 1998.
    1. Rodriguez P, Bonelli I, Setten M, Attie S, Maskin P, Kozima S, Valentini R. Electric neuromuscular stimulation for prevention of ICU-acquired paresis in patients with severe sepsis. Intensive Care Med. 2009;35:133–133.
    1. Schneider JB, Weber-Carstens S, Bierbrauer J, Marg A, Olbricht C, Hasani H, Spuler S. Electrical muscle stimulation in early severe critical illness prevents type 2 fiber atrophy. Neuromuscul Disord. 2011;21:744–744.
    1. Meesen RLJ, Dendale P, Cuypers K, Berger J, Hermans A, Thijs H, Levin O. Neuromuscular electrical stimulation as a possible means to prevent muscle tissue wasting in artificially ventilated and sedated patients in the intensive care unit: a pilot study. Neuromodulation. 2010;13:315–321. doi: 10.1111/j.1525-1403.2010.00294.x.
    1. Bouletreau P, Patricot MC, Saudin F, Guiraud M, Mathian B. Effects of intermittent electrical stimulations on muscle catabolism in intensive care patients. JPEN J Parenter Enteral Nutr. 1987;11:552–555. doi: 10.1177/0148607187011006552.
    1. Abdellaoui A, Prefaut C, Gouzi F, Couillard A, Coisy-Quivy M, Hugon G, Molinari N, Lafontaine T, Jonquet O, Laoudj-Chenivesse D. Skeletal muscle effects of electrostimulation after COPD exacerbation: a pilot study. Eur Respir J. 2011;38:781–788. doi: 10.1183/09031936.00167110.
    1. Gruther W, Kainberger F, Fialka-Moser V, Paternostro-Sluga T, Quittan M, Spiss C, Crevenna R. Effects of neuromuscular electrical stimulation on muscle layer thickness of knee extensor muscles in intensive care unit patients: a pilot study. J Rehabil Med. 2010;42:593–597. doi: 10.2340/16501977-0564.
    1. Poulsen JB, Moller K, Jensen CV, Weisdorf S, Kehlet H, Perner A. Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock. Crit Care Med. 2011;39:456–461. doi: 10.1097/CCM.0b013e318205c7bc.
    1. Rodriguez PO, Setten M, Maskin LP, Bonelli I, Vidomlansky SR, Attie S, Frosiani SL, Kozima S, Valentini R. Muscle weakness in septic patients requiring mechanical ventilation: protective effect of transcutaneous neuromuscular electrical stimulation. J Crit Care. 2012;27:e311–318.
    1. Zanotti E, Felicetti G, Maini M, Fracchia C. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Chest. 2003;124:292–296. doi: 10.1378/chest.124.1.292.
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174. doi: 10.2307/2529310.
    1. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532–555. doi: 10.1164/rccm.200703-456SO.
    1. Maffiuletti NA, Herrero AJ, Jubeau M, Impellizzeri FM, Bizzini M. Differences in electrical stimulation thresholds between men and women. Ann Neurol. 2008;63:507–512. doi: 10.1002/ana.21346.
    1. Bednarik J, Vondracek P, Dusek L, Moravcova E, Cundrle I. Risk factors for critical illness polyneuromyopathy. J Neurol. 2005;252:343–351. doi: 10.1007/s00415-005-0654-x.
    1. Harper NJ, Greer R, Conway D. Neuromuscular monitoring in intensive care patients: milliamperage requirements for supramaximal stimulation. Br J Anaesth. 2001;87:625–627. doi: 10.1093/bja/87.4.625.
    1. Maffiuletti NA, Minetto MA, Farina D, Bottinelli R. Electrical stimulation for neuromuscular testing and training: state-of-the art and unresolved issues. Eur J Appl Physiol. 2011;111:2391–2397. doi: 10.1007/s00421-011-2133-7.
    1. Vivodtzev I, Debigare R, Gagnon P, Mainguy V, Saey D, Dube A, Pare ME, Belanger M, Maltais F. Functional and muscular effects of neuromuscular electrical stimulation in patients with severe COPD: a randomized clinical trial. Chest. 2012;141:716–725. doi: 10.1378/chest.11-0839.
    1. Napolis LM, Dal Corso S, Neder JA, Malaguti C, Gimenes AC, Nery LE. Neuromuscular electrical stimulation improves exercise tolerance in chronic obstructive pulmonary disease patients with better preserved fat-free mass. Clinics (Sao Paulo) 2011;66:401–406. doi: 10.1590/S1807-59322011000300006.
    1. Vanderthommen M, Duchateau J. Electrical stimulation as a modality to improve performance of the neuromuscular system. Exerc Sport Sci Rev. 2007;35:180–185. doi: 10.1097/jes.0b013e318156e785.
    1. Gobbo M, Gaffurini P, Bissolotti L, Esposito F, Orizio C. Transcutaneous neuromuscular electrical stimulation: influence of electrode positioning and stimulus amplitude settings on muscle response. Eur J Appl Physiol. 2011;111:2451–2459. doi: 10.1007/s00421-011-2047-4.
    1. Sapega AA. Muscle performance evaluation in orthopaedic practice. J Bone Joint Surg Am. 1990;72:1562–1574.
    1. Maffiuletti NA. Assessment of hip and knee muscle function in orthopaedic practice and research. J Bone Joint Surg Am. 2010;92:220–229. doi: 10.2106/JBJS.I.00305.
    1. Gandevia SC. Spinal and supraspinal factors in human muscle fatigue. Physiol Rev. 2001;81:1725–1789.
    1. Man WD, Moxham J, Polkey MI. Magnetic stimulation for the measurement of respiratory and skeletal muscle function. Eur Respir J. 2004;24:846–860. doi: 10.1183/09031936.04.00029004.
    1. Rutkove SB. Electrical impedance myography: Background, current state, and future directions. Muscle Nerve. 2009;40:936–946. doi: 10.1002/mus.21362.
    1. Chuang LL, Wu CY, Lin KC. Reliability, validity, and responsiveness of myotonometric measurement of muscle tone, elasticity, and stiffness in patients with stroke. Arch Phys Med Rehabil. 2012;93:532–540. doi: 10.1016/j.apmr.2011.09.014.
    1. Pisot R, Narici MV, Simunic B, De Boer M, Seynnes O, Jurdana M, Biolo G, Mekjavic IB. Whole muscle contractile parameters and thickness loss during 35-day bed rest. Eur J Appl Physiol. 2008;104:409–414. doi: 10.1007/s00421-008-0698-6.
    1. Deem S. Intensive-care-unit-acquired muscle weakness. Respir Care. 2006;51:1042–1052. discussion 1052–1043.
    1. Hortobagyi T, Maffiuletti NA. Neural adaptations to electrical stimulation strength training. Eur J Appl Physiol. 2011;111:2439–2449. doi: 10.1007/s00421-011-2012-2.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir