Efeitos da estimulação elétrica neuromuscular (EENM) na função respiratória e motora de indivíduos críticos: Electrical neuromuscular stimulation (EENM) effects on respiratory and motor function in critically ill individuals

Anderson Procópio Viana; Zaqueline Fernandes Guerra; Arlete Ana Motter

doi:10.17765/2176-9206.2025v18e12985

Authors

Anderson Procópio Viana Federal University of Paraná https://orcid.org/0009-0006-3659-1959
Zaqueline Fernandes Guerra Faculty of Medical and Health Sciences of Juiz de Fora https://orcid.org/0000-0001-9044-8340
Arlete Ana Motter Federal University of Paraná https://orcid.org/0000-0002-2585-207X

DOI:

https://doi.org/10.17765/2176-9206.2025v18e12985

Keywords:

Electrical Stimulation Therapy, Physiotherapy, Intensive Care Unit

Abstract

Physiotherapeutic care planning for critically ill patients in Intensive Care Units progresses daily. Considering this fact, this study reported the effects of Neuromuscular Electrical Stimulation (NMES) on the respiratory and motor function of hospitalized patients using invasive ventilatory support. Based on an integrative review in the PubMed and PEDro databases, between November 2023 and February 2024, randomized clinical trials related to the topic were filtered and evaluated as well as their methodological quality. Initially, 128 articles were collected, with a final sample of 6 studies after assessing the inclusion criteria. It was possible to conclude that NMES in critically ill patients affects muscle strength gain, reduced hospitalization time, and shorter duration of Invasive Mechanical Ventilation (IMV), both in isolation and combination with conventional physiotherapy. Further studies on the subject are essential to better understand the potential of NMES in these patients.

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Author Biographies

Anderson Procópio Viana, Federal University of Paraná

Graduated in Physiotherapy from Salgado de Oliveira University - Juiz de Fora - MG (2017). Specialist in Physiotherapy in Adult Intensive Care from Faculdade Inspirar - Curitiba - PR (2021). Currently a public servant with the position of Physiotherapist in the Adult Intensive Care Unit of the Hospital and Maternity São José dos Pinhais - PR.

Zaqueline Fernandes Guerra, Faculty of Medical and Health Sciences of Juiz de Fora

Physiotherapist specializing in Cardiovascular Physiotherapy by COFFITO / ASSOBRAFIR (2022) and Physiotherapist specializing in Neurofunctional Physiotherapy for adults and the elderly with certification by COFFITO / ABRAFIN (2020). Post-doctorate in Rehabilitation Sciences from the FEDERAL UNIVERSITY OF MINAS GERAIS (UFMG), PhD in Health from the Stricto Sensu Postgraduate Program of the Faculty of Medicine of the Federal University of Juiz de Fora (UFJF) with the thesis "Effects of Mental Practice on the recovery of mobility after Stroke (CVA)". Master in Biodynamics of Human Movement from UFJF with the dissertation "Cardiac autonomic modulation at rest and in recovery after maximum effort". Graduated in Physiotherapy from UFJF in 2001. She has a Lato-sensu Postgraduate Degree in Neurofunctional Physiotherapy from the Catholic University of Petrópolis (UCP). She has been a professor of the Physiotherapy course at the Faculty of Medical and Health Sciences of Juiz de Fora (SUPREMA) since 2006, where she is responsible for the subjects of Neurofunctional Physiotherapy, Cardiovascular Physiotherapy, Neurophysiology and Complementary Exams, as well as a tutor in the course internship. She was a professor of the Physiotherapy course at Universidade Salgado de Oliveira (UNIVERSO) from 2005 to 2019, teaching the subjects of Cardiological Physiotherapy I and II, Neurological I and II, Neurophysiology and CBT I and II. She was a delegate of the Brazilian Association of Neurofunctional Physiotherapy - ABRAFIN- MG from 2016 to 2020 and is currently a member of ASSOBRAFIR and ABENFISIO.

Arlete Ana Motter , Federal University of Paraná

She holds a degree in Physiotherapy from the Pontifical Catholic University of Paraná (1992), a postgraduate degree in Cardio Respiratory Physiotherapy from UTP (1997) and Functional Orthopedic Trauma (2005) from COFFITO, a master's degree (2001) and a doctorate (2007) in Production Engineering, with an emphasis on Ergonomics, from the Federal University of Santa Catarina, and a postdoctorate in Occupational Psychology from the University of Porto, Portugal. She has advanced training in Global Postural Reeducation (RPG) and Iso Stretching. She was part of the first class of Temporary Physiotherapist Officers of the Ministry of Defense - Brazilian Army. She is an Associate Professor IV at the Federal University of Paraná, in the Physiotherapy Course, and a Professor in the Postgraduate Program in Public Health at UFPR. He has experience in the area of hospital, outpatient and clinical physiotherapy, working mainly in the following areas: ergonomics, worker health, cardiorespiratory and occupational physiotherapy.

References

1. Gomes VCL, Gomes VS, Oliveira NA. Intensive care medicine –ICU: Experiences, procedures and Technologies. Brazilian Journal of Health Review. 2023;6(2):7969-7981. https://doi.org/10.34119/bjhrv6n2-281

2. Brill NG, Rangel RF, Zamberlan C, Ilha S. Humanization of care in an intensive care unit: potentialities, challenges and strategies. Disciplinarum Scientia. 2020;21(2):113-125. https://doi.org/10.37777/dscs.v21n2-010

3. Aguiar LMM, Martins GS, Valduga R, Gerez AP, Carmo EC, Cunha KC, et al., Profile of adult intensive care units in Brazil: systematic review of observational studies. Rev. Bras Ter Intensiva. 2021;33(4):624-634. https://criticalcarescience.org/article/profile-of-adult-intensive-care-units-in-brazil-systematic-review-of-observational-studies/

4. Castro MLM, Almeida FAC, Amorim EH, Carvalho AILC, Costa CCC, Cruz RAO. Perfil de pacientes de uma unidade de terapia intensiva de adultos de um município paraibano. Revista Enfermeria Actual. 40:1-13. http://dx.doi.org/10.15517/revenf.v0i40.42910

5. Santos FV, Cipriano G, Vieira L, Chiappa AMG, Cipriano GBF, Vieira P, et al., Neuromuscular electrical stimulation combined with exercise decreases duration of mechanical ventilation in ICU patients: A randomized controlled trial. Physiotherapy Theory and Practice, 2020;36(5):1-9. https://www.tandfonline.com/doi/full/10.1080/09593985.2018.1490363

6. Miranda FEMH, Dias BCA, Macedo LB, Dias CMC. Eletroestimulação em doentes críticos: uma revisão sistemática. Revista Pesquisa em Fisioterapia. 2013;3(1):79-91. https://doi.org/10.17267/2238-2704rpf.v3i1.111

7. Cebeci GC, Cebeci H, Kucuk MP, Kucuk AO, Bayrak IK, Ulger F. Neuromuscular electrical stimulator as a Protective Treatment against Intensive Care Unit Muscle Wasting in Sepsis/Septic Shock Patients. J Coll Physicians Surg Pak. 2022;32(10):1300-1307. https://jcpsp.pk/article-detail/pneuromuscular-electrical-stimulator-as-a-protective-treatment-against-intensive-care-unit-muscle-wasting-in-sepsisorseptic-shock-patientsorp

8. Silva ACA, Aguiar FP, Sousa LAS, Silva MPSF, Moschella NL, Gardenghi G. Effects and application modes of neuromuscular electrical stimulation in critical ill patients. ASSOBRAFIR Ciência. 2016;7(1):59-68. https://assobrafirciencia.org/journal/assobrafir/article/5dd542840e88259051c8fca6

9. Mahran GSK, Mehany MM, Abbas MS, Shehata AER, Abdelhafeez AS, Obiedallah AA, et al., Short-Term Outcomes of Neuromuscular Electrical Stimulation in Critically Ill Patients. Crit Care Nurs Q. 2023;46(2):126-135. https://journals.lww.com/ccnq/abstract/2023/04000/short_term_outcomes_of_neuromuscular_electrical.3.aspx

10. Ayala LAS, Yamauchi LY. Efeitos da eletroestimulação neuromuscular nos desfechos clínicos e funcionais de pacientes internados em unidade de terapia intensiva: uma revisão integrativa. Instituto de Saúde e Sociedade. 2022; 1-27. https://hdl.handle.net/11600/62822

11. Castro IC, Matos RJC, Torres DC, Coelho CSC. Muscle weakness in intensive care unit patients with progressing Sepsis: an integrative review. Brazilian Journal of Development. 2023;9(6):19470-19479. https://doi.org/10.34117/bjdv9n6-051

12. Lins A, Souza DP, Baia BER, Pereira JCD, Leal NNM, Mangueira TAS. Effects of motor physiotherapy in adult patient with muscle weakness acquired in the Intensive Care Unit: systematic review. Brazilian Journal of Development. 2023;9(8):25207-25215. https://doi.org/10.34117/bjdv9n8-132

13. Maramattom BV, Wijdicks EFM. Acute neuromuscular weakness in the intensive care unit. Crit Care Med. 2006;34(11):2835-2841. https://journals.lww.com/ccmjournal/abstract/2006/11000/acute_neuromuscular_weakness_in_the_intensive_care.19.aspx

14. Gerovasili V, Stefanidis K, Vitzilaios K, Karatzanos E, Politis P, Koroneos A, et al. Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study. Crit Care. 2009;13(5):1-14. https://ccforum.biomedcentral.com/articles/10.1186/cc8123

15. Zanotti E, Felicetti G, Maini M, Fracchia C. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Clinical Investigation in critical care. 2003;124(1):292-296. https://journal.chestnet.org/article/S0012-3692(15)36023-2/abstract

16. Silva MHA, Soares VP, Sales M, Eutasquio MC, Dias MMMG, Souza DCB, et al. Aplicabilidade da estimulação elétrica funcional nas diferentes disfunções motoras de origem neurológica: uma revisão narrativa. Cadernos de Pós-Graduação em Distúrbios do Desenvolvimento. 2023;23(2):32-52. http://dx.doi.org/10.5935/cadernosdisturbios.v23n2p32-52

17. Zayed Y, Kheiri MRCP, Barmarawi M, Chintalapati S, Bachuwa GMHSA, Al-Sanouri I, et al. Effects of neuromuscular electrical stimulation in critically ill patients: A systematic review and meta-analysis of randomised controlled trials. Aust Crit Care. 2020;33(2):203-210. https://www.australiancriticalcare.com/article/S1036-7314(19)30001-3/abstract

18. Xu C, Yang F, Wang Q, Gao W. Effect of neuromuscular electrical stimulation in critically ill adults with mechanical ventilation: a systematic review and network meta-analysis. BMC Pulm Med. 2024;24(1):24-56. https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-02854-9Sevilla

19. GGP, Pinto BSP. Effectiveness of physical exercise and neuromuscular electrical stimulation interventions for preventing and treating intensive care unit-acquired weakness: A systematic review of randomized controlled trials. Intensive Crit Care Nurs. 2023;74:1-12. https://www.sciencedirect.com/science/article/abs/pii/S0964339722001367?via%3Dihub

20. Balke M, Teschler M, Schafer H, Papel P, Mooren FC, Schmitz B. Therapeutic Potential of Electromyostimulation (EMS) in Critically Ill Patients-A Systematic Review. Frontiers in Physiology. 2022;13:1-21. https://doi.org/10.3389/fphys.2022.865437

21. Campos DR, Bueno TBC, Anjos JSGG, Zoppi D, Dantas BG, Gosselink R, et al. Early Neuromuscular Electrical Stimulation in Addition to Early Mobilization Improves Functional Status and Decreases Hospitalization Days of Critically Ill Patients. Crit Care Med. 2022;50(7):1116-1126. https://journals.lww.com/ccmjournal/abstract/2022/07000/early_neuromuscular_electrical_stimulation_in.9.aspx

22. Jadad AR, Moore RAndrew, Carroll D, Jenkinson C, Reynolds DJohnM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control. Clin. Trials. 1996;17(1):1-12. https://www.sciencedirect.com/science/article/abs/pii/0197245695001344?via%3Dihub

23. Nakamura K, Kihata A, Naraba H, Kanda N, Takahashi Y, Sonoo T, et al. Efficacy of belt electrode skeletal muscle electrical stimulation on reducing the rate of muscle volume loss in critically ill patients: A randomized controlled trial. J Rehabil Med. 2019;51(9):705-711. https://medicaljournalssweden.se/jrm/article/view/9565

24. Silva PE, de Cássia Marqueti R, Livino-de-Carvalho K, de Araujo AET, Castro J, da Silva VM, et al. Neuromuscular electrical stimulation in critically ill traumatic brain injury patients attenuates muscle atrophy, neurophysiological disorders, and weakness: a randomized controlled trial. J Intensive Care. 2019;7:1-13. https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-019-0417-x

25. Othman SY, Elbiaa MA, Mansour ER, El-Menshawy AM, Elsayed SM. Effect of neuromuscular electrical stimulation and early physical activity on ICU-acquired weakness in mechanically ventilated patients: A randomized controlled trial. Nurs Crit Care. 2024;29(3):584-596. https://onlinelibrary.wiley.com/doi/10.1111/nicc.13010

26. Sponton J, Minosso M, Amendola F, Regina M, Alvarenga M, Amélia M, et al. Validation of the Barthel Index in elderly patients attended in outpatient clinics, in Brazil. Acta Paul Enferm. 2010;23(2):218-223. https://doi.org/10.1590/S0103-21002010000200011

27. Santana LGL, Rebequi R de S, Romero JR, Filoni E, Lazzareschi L, Santos EL dos, et al. Evaluation of Medium Frequency Neuromuscular Electric Stimulation (Aussie Current) in the Brachial Triceps Muscle Strength in a Non-Physically Active Woman. Revista Cientifica UMC. 2019;4(2):1-11. https://seer.umc.br/index.php/revistaumc/article/view/367

28. Reis FA dos, Palma C, Barbosa PIM, Reis FA dos, Pereira DM. Effectiveness of Aussie Current in the Improvement of Quadriceps Strength in bed restricted Individuals. Ensaios Cienc. 2018;2(22):112-118. https://doi.org/10.17921/1415-6938.2018v22n2p112-118

29. Silva VZM da, Araújo Neto JA de, Cipriano Júnior G, Pinedo M, Needham DM, Zanni JM, et al. Brazilian version of the Functional Status Score for the ICU: translation and cross-cultural adaptation. Rev Bras Ter Intensiva. 2017;29(1):34-38. https://criticalcarescience.org/article/brazilian-version-of-the-functional-status-score-for-the-icu-translation-and-cross-cultural-adaptation/

30. Souza GCR de, Cazotto GA, Simões GMS, Peyneau LG. Analysis of the functionality of patients in the ICUof a philanthropic hospital in Vitória-ES. Brazilian Journal of Development. 2022;8(4):32065-32073. https://doi.org/10.34117/bjdv8n4-610

31. Turton P, Hay R, Taylor J, McPhee J, Welters I. Human limb skeletal muscle wasting and architectural remodeling during five to ten days intubation and ventilation in critical care – an observational study using ultrasound. BMC Anesthesiology. 2016;119:1-8. https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-016-0269-z

32. Lima RVSA de, Fernandes JS, Sousa ASL de, Lima DT de, Rodrigues AF, Pedrosa R, et al. Análise ultrassonográfica do quadríceps femoral de pacientes críticos sob ventilação mecânica. Conscientiae Saúde. 2020;19(1):1-14. https://doi.org/10.5585/conssaude.v19n1.17090

33. Ward AR, Toumbourou SL, McCarthy B. A comparison of the analgesic efficacy of medium-frequency alternating current and TENS. Physiotherapy. 2009;95(4):280-288. https://www.physiotherapyjournal.com/article/S0031-9406(09)00083-2/abstract

34. Paula ABD, Carvalho OC, Spiguel LC, Cardoso RS, Arêas PT, Santana SAA. Impactos da eletroestimulação neuromuscular em pacientes internados em uti. Brazilian Journal of Implantology and Health Sciences. 2023;5(5):748-759. https://doi.org/10.36557/2674-8169.2023v5n5p748-759