Xu Cuiping, Yang Feng, Wang Qimin, Gao Wei
Department of Respiratory and Critical Care Medicine, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, China.
BMC Pulm Med. 2024 Jan 25;24(1):56. doi: 10.1186/s12890-024-02854-9.
Neuromuscular electrical stimulation (NMES) is widely used as a rehabilitation methods to restore muscle mass and function in prolonged immobilization individuals. However, its effect in mechanically ventilated patients to improve clinical outcomes remains unclear.
A comprehensive search was conducted using PubMed, Embase, Web of Science, PEDro, and the Cochrane Library from their inception until December 24th, 2023. The search targeted randomized controlled trials (RCTs) comparing NMES with physical therapy (PT) or usual ICU care (CG), for improving clinical outcomes in mechanically ventilated patients. We performed a network meta-analysis utilizing Stata version 14.0 and R 4.3.1.
We included 23 RCTs comprising 1312 mechanically ventilated adults. The treatments analyzed were NMES, PT, NMES combined with PT (NMES+PT), and CG. Network meta-analyses revealed that NMES or NMES+PT significantly improved extubation success rate compared to CG, with ORs of 1.85 (95% CI: 1.11, 3.08) and 5.89 (95% CI: 1.77, 19.65), respectively. Additionally, NMES exhibited a slight decrease in extubation success rate compared with NMES+PT, with OR of 0.31 (95% CI: 0.11, 0.93). Nevertheless, neither NMES nor NMES+PT showed any significant improvement in ICU length of stay (LOS), ventilation duration, or mortality when compared with PT or CG. NMES+PT emerged as the most effective strategy for all considered clinical outcomes according to the ranking probabilities. The evidence quality ranged from "low" to "very low" in this network meta-analysis.
NMES appears to be a straightforward and safe modality for critically ill, mechanically ventilated patients. When combined with PT, it significantly improved the extubation success rate against standard ICU care and NMES alone, and showed a better ranking over PT or NMES alone for clinical outcomes. Therefore, NMES combined with PT may be a superior rehabilitation strategy for this patient group.
神经肌肉电刺激（NMES）作为一种康复方法被广泛应用于长期制动个体，以恢复肌肉质量和功能。然而，其对机械通气患者临床结局的改善作用仍不明确。
使用PubMed、Embase、Web of Science、PEDro和Cochrane图书馆进行全面检索，检索时间从各数据库建库至2023年12月24日。检索目标为比较NMES与物理治疗（PT）或常规重症监护病房护理（CG）对改善机械通气患者临床结局的随机对照试验（RCT）。我们使用Stata 14.0版本和R 4.3.1进行网络荟萃分析。
我们纳入了23项RCT，共1312例机械通气的成年人。分析的治疗方法包括NMES、PT、NMES联合PT（NMES+PT）和CG。网络荟萃分析显示，与CG相比，NMES或NMES+PT显著提高了拔管成功率，其比值比分别为1.85（95%置信区间：1.11，3.08）和5.89（95%置信区间：1.77，19.65）。此外，与NMES+PT相比，NMES的拔管成功率略有下降，比值比为0.31（95%置信区间：0.11，0.93）。然而，与PT或CG相比，NMES和NMES+PT在重症监护病房住院时间（LOS）、通气时间或死亡率方面均未显示出显著改善。根据排序概率，NMES+PT是所有考虑的临床结局中最有效的策略。在该网络荟萃分析中，证据质量从“低”到“极低”不等。
对于重症机械通气患者，NMES似乎是一种简单且安全的治疗方式。与PT联合使用时，与标准重症监护病房护理和单独使用NMES相比，它显著提高了拔管成功率，并且在临床结局方面比单独使用PT或NMES表现更好。因此，NMES联合PT可能是该患者群体的一种更优康复策略。
