Effect of neuromuscular electrical stimulation and early physical activity on ICU-acquired weakness in mechanically ventilated patients: A randomized controlled trial

Background: Intensive care unit-acquired weakness (ICU-AW) is common in critically ill patients and increases the duration of mechanical ventilation (MV) and weaning time. Early mobilization, range of motion (ROM) exercises, and neuromuscular electrical stimulation (NMES) can prevent ICU-AW by maintaining muscle mass. However, studies highlighting the effects of combining NMES with early physical activity in ICU patients are limited.Aim: To evaluate the effect of NMES and early physical activity on ICU-AW in mechanically ventilated patients.Design: A single-blinded randomized controlled trial was conducted in Alexandria, Egypt.Method: Patients were randomly assigned to one of four groups: NMES, ROM, combined therapy (ROM + NMES), or conventional care (control group). The Medical Research Council (MRC) scale was used to assess the ICU-AW for the study patients over a 7-day period. The duration of the patient's MV and ICU stays were recorded.Results: Of the 180 patients who were assessed for eligibility, 124 were randomly assigned to one of four groups: 32 patients in ROM exercises, 30 in NMES, 31 in combined therapy (ROM + NMES), and 31 in the control group. On day 7, ROM + NMES and NMES groups showed higher MRC scores than ROM and control groups (50.37 +/- 2.34, 49.77 +/- 2.19, 44.97 +/- 3.61, and 41.10 +/- 3.84, respectively). ANOVA test results indicated significant differences (p < .001) across the four groups. ICU-AW occurred in 0% of the ROM + NMES group, 60% of the ROM group, 13% of the NMES group, and 100% of the control group (p < .001). The MV duration (in days) in the ROM + NMES group was shorter (12.80 +/- 3.800) than in the ROM, NMES, or control groups (21.80 +/- 4.460, 18.73 +/- 4.748, and 20.70 +/- 3.932, respectively). ICU-LOS was shorter in the ROM + NMES group (17.43 +/- 3.17 days) compared with the ROM group (22.53 +/- 4.51 days), the NMES group (21.10 +/- 5.0 days), and the control group (21.50 +/- 4.42 days) with significant differences (p < .001) between the four groups.Conclusion: Daily sessions of NMES and early physical activity were well tolerated, preserved muscle strength, prevented ICU-AW, and decreased the duration of the MV and ICU stay.