Effect of Electrical Muscle Stimulation on Upper and Lower Limb Muscles in Critically Ill Patients : A Two-Center Randomized Controlled Trial

Objectives: Electrical muscle stimulation (EMS) is widely used to enhance lower limb mobilization. Although upper limb muscle atrophy is common in critically ill patients, EMS application for the upper limbs has been rarely reported. The purpose of this study was to investigate whether EMS prevents upper and lower limb muscle atrophy and improves physical function.
Design: Randomized controlled trial.
Setting: Two-center, mixed medical/surgical intensive care unit (ICU).
Patients: Adult patients who were expected to be mechanically ventilated for >48 h and stay in the ICU for >5 days.
Interventions: Forty-two patients were randomly assigned to the EMS (n = 17) or control group (n = 19).
Measurements and Main Results: Primary outcomes were change in muscle thickness and cross-sectional area of the biceps brachii and rectus femoris from day 1 to 5. Secondary outcomes included incidence of ICU-acquired weakness (ICU-AW), ICU mobility scale (IMS), length of hospitalization, and amino acid levels. The change in biceps brachii muscle thickness was −1.9% vs. −11.2% in the EMS and control (p = 0.007) groups, and the change in cross-sectional area was −2.7% vs. −10.0% (p = 0.03). The change in rectus femoris muscle thickness was −0.9% vs. −14.7% (p = 0.003) and cross-sectional area was −1.7% vs. −10.4% (p = 0.04). No significant difference was found in ICU-AW (13% vs. 40%; p = 0.20) and IMS (3 vs. 2; p = 0.42) between the groups. The length of hospitalization was shorter in the EMS group (23 [19–34] vs. 40 [26–64] days) (p = 0.04). On day 3, the change in the branched-chain amino acid level was lower in the EMS group (40.5% vs. 71.5%; p = 0.04).
Conclusion: In critically ill patients, EMS prevented upper and lower limb muscle atrophy and attenuated proteolysis and decreased the length of hospitalization.