Early Application of Neuromuscular Electrical Stimulation Prevents Excessive Muscle Wasting in Critically Ill Patients in the Intensive Care Unit
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Background: Intensive Care Unit-Acquired Weakness (ICU-AW) is a common neuromuscular complication in critically ill patients, leading to muscle atrophy, prolonged mechanical ventilation and impaired functional recovery. Effective rehabilitation strategies play crucial role in maintaining muscle strength. Neuromuscular electrical stimulation (NMES) had shown potential in preserving quadriceps femoris muscle thickness. This study aimed to examine the effect of NMES to quadriceps femoris muscle thickness in patient with ICU-AW.
Methods: Patients that stayed in ICU more than 48 hours and used mechanical ventilation for at least 24 hours enrolled in one-group pretest-posttest design. Neuromuscular electrical stimulation applied to bilateral quadriceps femoris for 30 minutes daily over five consecutive days. Bilateral quadriceps femoris muscle thickness were assessed with USG day before and after therapy.
Results: Twenty ICU-AW patients were enrolled from December 2023 to June 2024, and 13 of them completed the study. There were no significant changes in the thickness of the right and left quadriceps femoris muscle before and after 5-days of NMES therapy (p = 0.910 and p = 0.519, respectively). However, we preserved less than 5% decreased of muscle thickness.
Conclusions: Early 5-days of NMES therapy did not increase quadriceps femoris muscle thickness but effectively prevented further muscle degradation in ICU-AW patients. The potential benefits of rehabilitation therapy in ICU-AW patients should be further explored in future studies with controlled indicators and larger sample sizes.
Nonoyama T, Shigemi H, Kubota M, Matsumine A, Shigemi K, Ishizuka T. Neuromuscular electrical stimulation in the intensive care unit prevents muscle atrophy in critically ill older patients: a retrospective cohort study. Medicine (Baltimore). 2022;101:e29451.
Yang T, Li Z, Jiang L, Wang Y, Xi X. Risk factors for intensive care unit-acquired weakness: a systematic review and meta-analysis. Acta Neurol Scand. 2018;138:104–14.
Zayed Y, Kheiri B, Barbarawi M, Chaine A, Rashdan L, Chintalapati S, Bachuwa G, et al. Effect of neuromuscular electrical stimulation in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Aust Crit Care. 2019;33:203–210.
Cameron MH. Physical Agents in Rehabilitation: An Evidence-Based Approach to Practice. 5th ed. St. Louis (MO): Elsevier; 2018.
Leite M, Osaku E, Albert J, de Macedo Costa C, Garcia A, Czapiesvski FD, Ogasawara S, et al. Effect of neuromuscular electrical stimulation of the quadriceps and diaphragm in critically ill patients: a pilot study. Crit Care Res Pract. 2018;2018:4298583.
Kusumawardani M, Poerwandari D, Narasinta I, Hidayati H, Subadi I. The role of neuromuscular electrical stimulation for rehabilitation in ICU-acquired weakness. Anaesth Pain Intensive Care. 2018;22:S164–9.
Katsogianni A, Vasileiadis I, Petrocheilou G, Patsaki E, Sidiras G, Nanas S, Stranjalis G, et al. Effect of different neuromuscular electrical stimulation protocols on muscle mass in intensive care unit patients: a pilot study. Health Sci J. 2019;13:653.
Segers J, Vanhorebeek I, Langer D, Charususin N, Wei W, Frickx B, Demeyere I, et al. Early neuromuscular electrical stimulation reduces the loss of muscle mass in critically ill patients – a within-subject randomized controlled trial. J Crit Care. 2021;62:65–71.
Engelhardt LJ, Grunow JJ, Wollersheim T, Carbon NM, Balzer F, Spranger J, Weber-Carstens S. Sex-specific aspects of skeletal muscle metabolism in the clinical context of intensive care unit-acquired weakness. J Clin Med. 2022;11(3):846
Maritska Z, Parisa N, Karina M, Putra MM, Eliska N, Irga M, Manurung MRS, Saputra A. Anesthetic considerations in patients with mitochondrial disorders. Indones J Anesth Reanim. 2023;5(2):102–11.
Stevenson R, Bishop DG, Rodseth RN. A review of the role of testosterone in the care of the critically ill patient. S Afr J Crit Care. 2024;40(1):e1303.
Koga Y, Fujita M, Harada K, Shin M, Ayata R, Inoue T, Kaneda K, et al. Increased fat accumulation may be associated with severe muscle wasting in critically ill patients: a prospective observational study. Sci Rep. 2025;15:11460.
Pearson SD and Patel BK. Evolving targets for sedation during mechanical ventilation. Curr Opin Crit Care. 2019;26(1):47–52.
Lambden S, Laterre PF, Levy MM, François B. The SOFA score—development, utility and challenges of accurate assessment in clinical trials. Crit Care. 2019;23:374.
Kamath AC and Harsoor S. Study of SOFA score for predicting the outcome of patients admitted in ICU at BTGH. Al Ameen J Med Sci. 2020;13(2):125–9.
Saseedharan S, Chada R, Rambhad S, Bhurke A, Mathew E, Paradkar K. Muscle mass loss in mechanically ventilated critically ill patients in intensive care unit. Muscle Ligaments Tendons J. 2023;13(2):290–6.
Zhang W, Wu J, Gu Q, Gu Y, Zhao Y, Ge X, et al. Changes in muscle ultrasound for the diagnosis of intensive care unit-acquired weakness in critically ill patients. Sci Rep. 2021;11(1):18280.
Campos DR, Bueno TBC, Anjos JSSG, Zoppi D, Dantas BG, Gosselink R, et al. Early neuromuscular electrical stimulation in addition to early mobilization improves functional status and decreases hospitalization days in critically ill patients. Crit Care Med. 2022;50(7):1116–26.
Yustiawan A, Semedi BP, Arfianti L, Hidayati HB, Maulydia, Edwar P. The effect of early neuromuscular electrical stimulation in intensive care unit-acquired weakness. Anaesth Pain Intensive Care. 2024;28(4).
Nakanishi N, Oto J, Tsutsumi R, Yamamoto T, Ueno Y, Nakataki E, et al. Effect of electrical muscle stimulation on upper and lower limb muscles in critically ill patients: a two-center randomized controlled trial. Crit Care Med. 2020;48(11):e997–e1003.
Flower L and Puthucheary Z. Muscle wasting in the critically ill patient: how to minimise subsequent disability. Br J Hosp Med (Lond). 2020;81(6):1–9.
Fazzini B, Märkl T, Costas C, Blobner M, Schaller S, Prowle J, et al. The rate and assessment of muscle wasting during critical illness: a systematic review and meta-analysis. Crit Care. 2023;27:2.
Baron MV, Silva PE, Koepp J, Urbanetto JS, Santamaria AFM, dos Santos MP, de Mello Pinto MV, et al. Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial. Ann Intensive Care. 2022;12:53.
Guerra-Vega P, Guzmán R, Betancourt C, Grage M, Vera C, Artigas-Arias M, Muñoz-Cofré R, et al. Medium-frequency neuromuscular electrical stimulation in critically ill patients promoted larger functional capacity improvement during recovery than low-frequency neuromuscular electrical stimulation: randomized clinical trial. J Clin Med. 2025;14(15):5407.
Xu C, Yang F, Wang Q, Gao W. Effect of neuromuscular electrical stimulation in critically ill adults with mechanical ventilation: a systematic review and network meta-analysis. BMC Pulm Med. 2024;24(1):56.
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Journal of Orthopaedi and Traumatology Surabaya (JOINTS) is licensed under a Creative Commons Attribution-Non Commercial-Share Alike 4.0 International License.
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