Burke et al., 2016 [26]

Systematic review and meta-analysis

12 studies (11 RCTs and 1 control case) evaluated 449 ICU patients. The patients had a mean age between 34 and 72 years of age.

To evaluate the evidence on the efficacy of NMES compared to usual care in ICU.

Duration of the protocol: between 7 to 30 days or until extubation, discharge from the ICU or until the patient was able to voluntarily move the limbs or achieve a muscle strength score in 4 of 5. MG: quadriceps, anterior tibial, triceps sural, biceps brachii. F: between 35 - 100 Hz; I: 15 mA - 150 mA and some studies up to visible contraction, up to the maximum tolerated level and one study until producing pain. T: 200 - 400 μs; RT: 30 to 60 min.

This review provides evidence that NMES increases muscle strength and shows potential benefit for joint range of motion, muscle atrophy, MV outcomes, and limited activities in the critical patient.


Silva et al., 2017 [17]

Prospective observational study

11 critically ill male patients with a mean age of 39 years and receiving MV in ICUs, received NMES in bilateral LL. Before and after the application of the protocol blood samples were collected and analyzed.

To evaluate the safety and viability of an NMES protocol based on neuromuscular excitability and applied to various muscle groups.

The sessions took place for three consecutive days. Based on chronaxie and rheobase evaluated daily the NMES protocol was performed with a total of 45 min. MG = maximum gluteus and gastrocnemius (15 min bilateral and simultaneous application). Tibialis anterior and hamstrings (15 min simultaneously). Thigh quadriceps (15 min bilaterally). T: same as chronaxie. F: 100 Hz, Ton: 5 s and Toff: 5 s. The intensity was standardized and corrected from the highest visible contraction. P: rectangular bipolar.

The protocol employed was safe and feasible. The differences in neuromuscular excitability between different muscle groups and patients demonstrated the possibility of using customized protocols based on chronaxie.