Early Neuromuscular Electrical Stimulation and In-Bed Leg Cycling Preserve Quadriceps Femoris Muscle Thickness in Critically Ill Patients.

BACKGROUND AND PURPOSE: Muscle atrophy occurs early in critical illness, particularly in the leg muscles, which are most vulnerable to weakness due to immobility in the intensive care unit (ICU). However, the efficacy of early neuromuscular electrical stimulation (NMES) and in-bed leg cycling added to standardized rehabilitation as a strategy to prevent quadriceps femoris muscle atrophy in critically ill patients remains uncertain. This study aimed to investigate the effects of early NMES and in-bed leg cycling on quadriceps muscle thickness (QMT) and muscular strength in critically ill patients.

METHODS

This prospective quasi-experimental study included 36 critically ill adult patients within the first 24 h of mechanical ventilation after admission. Patients were allocated into three groups: NMES added to standardized rehabilitation group (n = 12), in-bed cycling exercise added to standardized rehabilitation group (n = 12) or standardized rehabilitation group (n = 12). The following outcomes were assessed: QMT (ultrasound) and global muscle strength (Medical Research Council-MRC-Sum Score).

RESULTS

The standardized rehabilitation group showed a significant reduction in QMT (p = 0.001). The NMES group (p < 0.01) and in-bed cycling group (p < 0.001) preserved QMT compared to the standardized rehabilitation group. An increase in global muscle strength was observed in the NMES (p < 0.001) and in-bed cycling groups (p < 0.001), although no differences were found among the three groups.

DISCUSSION: Our findings suggest that NMES and in-bed cycling exercise may be effective in preserving QMT in critically ill patients. Larger trials are required to confirm the efficacy of NMES and in-bed cycling exercise on muscle mass preservation and improvement in global muscle strength in ICU patients.