Effect of Neuromuscular Electrical Stimulation for Older Critically Ill Patients in the ICU: A Randomized Controlled Trial.

OBJECTIVES

In the ICU, the optimal patient population for neuromuscular electrical stimulation (NMES) and the most appropriate evaluation tools remain unclear. This study aimed to assess whether combining early mobilization with NMES in older critically ill patients improves lower limb muscle strength and physical function at hospital discharge.

DESIGN

Assessor-blinded, randomized controlled trial.

SETTING

A single-center, emergency and critical care center ICU in Japan.

PATIENTS: Patients 65 years old or older with an Acute Physiology and Chronic Health Evaluation II (APACHE II) score greater than 20 admitted to the ICU.

INTERVENTIONS: The participants were randomly assigned to the NMES group (NMES in addition to early mobilization) or the control group (early mobilization alone).

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was quadriceps isometric strength (QIS), which was measured using a hand-held dynamometer to ensure objective assessment. QIS values were normalized to body weight. Outcome assessors were blinded to group allocation. A total of 44 patients were randomized, and 32 completed the study (NMES group: 17; control group: 15). The mean age was 77.6 ± 6.5 years, and the mean APACHE II score was 29.7 ± 6.3. NMES was performed for an average of 9.6 ± 4.8 days. There were no baseline differences between groups. At hospital discharge, the mean QIS was 0.46 ± 0.13 kgf/kg in the NMES group and 0.30 ± 0.13 kgf/kg in the control group (mean difference, 0.16; 95% CI, 0.07-0.25; p = 0.002). Secondary outcomes, including the 6-minute walk distance and the Barthel Index, were also greater in the NMES group.

CONCLUSIONS

NMES combined with early mobilization improved lower limb muscle strength and functional outcomes in older ICU patients.