The impact of neuromuscular electrical stimulation combined with exercise compared to exercise alone on patient mortality, weaning from mechanical ventilation, length of icu and hospital stay, muscle strength, functional status, and health-related quality of life in icu patients

ABSTRACT THE IMPACT OF NEUROMUSCULAR ELECTRICAL STIMULATION COMBINED WITH EXERCISE COMPARED TO EXERCISE ALONE ON PATIENT MORTALITY, WEANING FROM MECHANICAL VENTILATION, LENGTH OF ICU AND HOSPITAL STAY, MUSCLE STRENGTH, FUNCTIONAL STATUS, AND HEALTH-RELATED QUALITY OF LIFE IN ICU PATIENTS Critically ill patients admitted to the Intensive Care Unit (ICU) often encounter muscle weakness from the early days of their admission. This weakness, not attributable to any neuromuscular disease, is termed ICU-Acquired Weakness (ICU-AW) due to its association with the ICU environment. ICU-AW is linked with difficulty in weaning from the ventilator, prolonged ICU stays, increased hospital costs, and higher long-term morbidity and mortality. In our study, we investigated the method of electrical stimulation using a Neuromuscular Electrical Stimulation (NMES) device, which is one of the methods used for the prevention and treatment of ICU-AW. The primary outcome of our study was the effect of NMES on patient mortality, duration of mechanical ventilation, and length of stay in the ICU and hospital. As secondary outcomes, we also examined the impact of NMES on muscle strength, functional status, and health-related quality of life. The study was conducted on patients who met the inclusion and exclusion criteria and were followed in Anesthesiology and Reanimation ICU-1 and ICU-2. Patients were divided into two groups. Muscle strength of the upper and lower extremities was measured at baseline for each patient. Upper extremity strength was assessed using a hand dynamometer, referencing the dominant hand. Lower extremity muscle strength was measured using a manual muscle test. To determine the functional status of the patients, the Functional Independence Measure (FIM) scale was used, and the SF-36 test was employed to assess health-related quality of life. During treatment, Group I received only the exercises prescribed by the Physical Therapy and Rehabilitation Department, while Group II received both the prescribed physical exercises and NMES at targeted voltages for the biceps and quadriceps muscles. No difference in mortality was found between the groups (p=0.569). However, in Group II, the duration of weaning from mechanical ventilation (p<0,05), length of ICU stay (p<0,05), and length of hospital stay (p<0,05) were significantly shorter. The upper extremity muscle strength at discharge in Group II was significantly higher (p<0,05). The proportion of patients in Group II with a lower extremity muscle strength of 5/5 at discharge was not statistically significant (p=0.078). The functional capacity at discharge in Group II was significantly higher (p<0,05). Additionally, the scores for emotional role difficulty at discharge (p<0,05), vitality at baseline (p<0,05), vitality at discharge (p<0,05), mental health at discharge (p<0.001), pain at discharge (p<0,05), and general health at discharge (p<0,05) were significantly higher in Group II. Statistical analyses were conducted using the SPSS (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL) version 22 software package. Descriptive data in the study are presented as numbers and percentages for categorical data, and as mean ± standard deviation (Mean±SD) for continuous data. The Pearson Chi-square test was used for comparing categorical variables between groups. The Kolmogorov-Smirnov test was used to assess the normality of distribution for continuous variables. The Student t-test was used for normally distributed variables, and the Mann-Whitney U test was used for non-normally distributed variables. The Wilcoxon analysis was used to evaluate the pre- and post-treatment functional capacity and SF-36 subscale scores of the patients. A p-value of <0.05 was considered statistically significant. Neuromuscular Electrical Stimulation shortened the duration of weaning from mechanical ventilation, reduced ICU and hospital stays, and improved muscle strength, functional status, and health-related quality of life in ICU patients. Consequently, NMES is a potential method for the prevention and treatment of ICU-AW. Keywords: ICU-Acquired Weakness, Neuromuscular Electrical Stimulation, muscle weakness