Balke Maryam, Teschler Marc, Schäfer Hendrik, Pape Pantea, Mooren Frank C, Schmitz Boris
St. Marien Hospital Cologne, Department of Early Rehabilitation, Cologne, Germany.
Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany.
Front Physiol. 2022 May 9;13:865437. doi: 10.3389/fphys.2022.865437. eCollection 2022.
Ample evidence exists that intensive care unit (ICU) treatment and invasive ventilation induce a transient or permanent decline in muscle mass and function. The functional deficit is often called ICU-acquired weakness with critical illness polyneuropathy (CIP) and/or myopathy (CIM) being the major underlying causes. Histopathological studies in ICU patients indicate loss of myosin filaments, muscle fiber necrosis, atrophy of both muscle fiber types as well as axonal degeneration. Besides medical prevention of risk factors such as sepsis, hyperglycemia and pneumonia, treatment is limited to early passive and active mobilization and one third of CIP/CIM patients discharged from ICU never regain their pre-hospitalization constitution. Electromyostimulation [EMS, also termed neuromuscular electrical stimulation (NMES)] is known to improve strength and function of healthy and already atrophied muscle, and may increase muscle blood flow and induce angiogenesis as well as beneficial systemic vascular adaptations. This systematic review aimed to investigate evidence from randomized controlled trails (RCTs) on the efficacy of EMS to improve the condition of critically ill patients treated on ICU. A systematic search of the literature was conducted using PubMed (Medline), CENTRAL (including Embase and CINAHL), and Google Scholar. Out of 1,917 identified records, 26 articles (1,312 patients) fulfilled the eligibility criteria of investigating at least one functional measure including muscle function, functional independence, or weaning outcomes using a RCT design in critically ill ICU patients. A qualitative approach was used, and results were structured by 1) stimulated muscles/muscle area (quadriceps muscle only; two to four leg muscle groups; legs and arms; chest and abdomen) and 2) treatment duration (≤10 days, >10 days). Stimulation parameters (impulse frequency, pulse width, intensity, duty cycle) were also collected and the net EMS treatment time was calculated. A high grade of heterogeneity between studies was detected with major cofactors being the analyzed patient group and selected outcome variable. The overall efficacy of EMS was inconclusive and neither treatment duration, stimulation site or net EMS treatment time had clear effects on study outcomes. Based on our findings, we provide practical recommendations and suggestions for future studies investigating the therapeutic efficacy of EMS in critically ill patients. : [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021262287].
有充分证据表明，重症监护病房（ICU）治疗和有创通气会导致肌肉质量和功能出现短暂或永久性下降。这种功能缺陷通常被称为ICU获得性肌无力，危重病性多神经病（CIP）和/或肌病（CIM）是主要潜在病因。对ICU患者的组织病理学研究表明，肌球蛋白丝丢失、肌纤维坏死、两种肌纤维类型萎缩以及轴突变性。除了对脓毒症、高血糖和肺炎等危险因素进行医学预防外，治疗仅限于早期被动和主动活动，三分之一从ICU出院的CIP/CIM患者从未恢复到住院前的身体状况。已知肌电刺激[EMS，也称为神经肌肉电刺激（NMES）]可改善健康肌肉和已萎缩肌肉的力量和功能，并可能增加肌肉血流量、诱导血管生成以及产生有益的全身血管适应性变化。本系统评价旨在调查随机对照试验（RCT）中关于EMS改善ICU危重病患者病情疗效的证据。使用PubMed（医学索引数据库）、CENTRAL（包括Embase和护理学与健康领域数据库）和谷歌学术进行文献系统检索。在1917条检索到的记录中，26篇文章（1312例患者）符合纳入标准，即采用RCT设计对危重症ICU患者至少一项功能指标进行研究，包括肌肉功能、功能独立性或脱机结果。采用定性方法，结果按以下方式分类：1）受刺激的肌肉/肌肉区域（仅股四头肌；两到四组腿部肌肉；腿部和手臂；胸部和腹部）和2）治疗持续时间（≤10天，>10天）。还收集了刺激参数（脉冲频率、脉冲宽度、强度、占空比）并计算了净EMS治疗时间。研究间存在高度异质性，主要协变量为分析的患者组和选定的结局变量。EMS的总体疗效尚无定论，治疗持续时间、刺激部位或净EMS治疗时间对研究结果均无明确影响。基于我们的研究结果，我们为未来研究EMS对危重病患者的治疗效果提供了实用建议。：[https://www.crd.york.ac.uk/prospero/]，标识符[CRD42021262287]
