Neuromuscular electrical stimulation as an alternative means of exercise for the critically ill

Neuromuscular electrical stimulation (NMES) makes use of electrical currents to activate the skeletal muscle and induce muscular contraction. The physics of the process and the ways of NMES application are discussed in this review. The local and systematic physiological effects of NMES are also pointed out. NMES is currently used in training and sports medicine for improvement of performance and rehabilitation after sports injuries. It is applied in nervous system diseases, for the activation of paralysed muscle groups so that they can carry out specific tasks, a technique known as functional electrical stimulation (FES). Its use for the prevention of deep vein thrombosis and for the treatment of venous deficiency and intermittent claudication is under investigation. Because of the increase in metabolism that it stimulates, NMES could be useful in the treatment of diabetes mellitus (DM) and obesity. The use of NMES in the rehabilitation of patients with chronic heart failure (CHF) and chronic obstructive pulmonary deficiency (COPD) is also discussed. Skeletal mass dysfunction is a crucial factor contributing to the impairment of functional capacity in these patients. It has been shown that exercise training rehabilitation programs may reverse these abnormalities and improve the patients' clinical condition, but patients with severely compromised exercise capacity may have difficulty in attending such programs. NMES provides the possibility of increasing muscle strength and aerobic capacity effortlessly and with no significant strain on the cardiopulmonary system, which makes it an alternative means of exercise for these patients. The results of rehabilitation programs using NMES for patients with CHF and COPD support this concept. Critical illness polyneuromyopathy (CIPMN) is a common problem in Intensive Care Unit (ICU) patients. It causes difficulty in weaning the patients from mechanical ventilation, prolongs the length of their ICU stay and increases mortality. A study on the use of NMES for the prevention of CIPMN is currently being carried out. Preliminary results indicate its beneficial effect on microcirculation and preservation of muscle mass in ICU patients.