Skeletal muscle atrophy in critical ill patients and the use of electrical stimulation as a treatment strategy: Recommendations for clinical practice

Abstract

Background: Skeletal muscle atrophy is a relevant and common problem in patients admitted to intensive care units (ICU). It is an imbalance between the muscle protein synthesis/degradation pathways and its onset is due to situations to which these patients are exposed, such as: disuse, corticoids, inflammatory cytokines, and others. Neuromuscular electrical stimulation (NMES) has been proposed as a safe and effective intervention. This review aims to establish the effectiveness of NMES in the modification of skeletal muscle mass/strength in critical patients and establish recommendations/limitations for its use in clinical practice. Methodology: A review of the available literature on clinical trials was carried out in the following databases: Medline/Pubmed, Pedro, Central, Science Direct, Web of Science, Embase and CINAHL. Finally, seven articles were included in the review. The seven articles included were evaluated by two authors (PS-J and PG-V) according to the PEDro scale. Three of these were of high quality and four of moderate quality. Results: NMES is a little used treatment strategy in practice, but it has demonstrated clinical and molecular benefits for the patients who pass through the ICU. Seven articles were included in the review and were evaluated according to the PEDro scale by two authors (PS-J and PG-V). NMES has demonstrated clinical and molecular benefits for the patients who pass through the ICU. Conclusion: NMES added to conventional therapy in ICU patients has proven to be effective in improving skeletal muscle mass and strength. NMES protocols in critically ill patients should start early (at least 24 or 48 hours after admission) and stimulating large muscle groups (upper and lower extremities). The clinical stability and possible contraindications must also be borne in mind, even though adverse effects are rare.