Long-Term Effects of the Association of Early Neuromuscular Electrical Stimulation With Mobilization in Critically Ill Patients

Objectives: To assess the long-term effects of the early combination of neuromuscular electrical stimulation (NMES) and early mobilization (EM) in critically ill patients. Design: Single-Center, randomized, controlled, and blinded clinical trial Setting: Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo. Patients: Seventy-four patients who had been mechanically ventilated were randomized into two groups within the first 48 hours of ICU admission. Interventions: One group received daily EM starting within first 48 hours of ICU admission (EM group). The other group received the same EM protocol plus NMES, applied 5 days a week, also starting within the first 48 hours of ICU admission until ICU discharge (EM + NMES group). Measurements and Main Results: After hospital discharge, patients were assessed by telephone at 15 days and 6 months, and in person at 30 days and 3 months. Functional status, muscle strength, functional independence, quality of life, and symptoms of post-traumatic stress disorder (PTSD) were assessed. Baseline demographic and clinical characteristics were similar between groups. Patients in the EM + NMES group had significantly higher functional status, independence, and mobility compared with those in the EM group at all time points, as measured by the Barthel Index at 15 and 30 days, and at 3 and 6 months ( p < 0.05), and the ICU Mobility Scale at 15 days, and at 3 and 6 months ( p < 0.05). Additionally, quality of life was significantly improved in the EM + NMES group compared with the EM group, up to 6 months after hospital discharge ( p < 0.05). There was no significant difference in PTSD scores between groups. Conclusions: The application of early NMES in addition to an EM protocol, when initiated within the first 48 hours of ICU admission, resulted in better functional outcomes and quality of life for critically ill patients up to 6 months post-discharge.