Electrical muscle stimulation for prevention of critical illness polyneuropathy

Excerpt

We read with interest the study by Routsi and colleagues showing that electrical muscle stimulation (EMS) reduced the frequency of critical illness polyneuropathy in intensive care unit (ICU) patients [1]. The authors stated that an intention-to-treat analysis was used. One hundred and forty patients were randomized to electrical stimulation or to usual care. Measurement of the main outcome could only be performed in cooperating patients surviving after awakening. Thus, 39 patients (57%) and 44 patients (61%) who died or who had impaired cognitive state were excluded from analysis in each arm. Data from five out of 29 subjects on the intervention arm were also excluded from the final analysis because of neuromuscular blocker use (n = 3) or a lack of electrical stimulation during the ICU stay (n = 2). The latter probably induced a selection bias, as subjects receiving neuromuscular blockers have increased risk of critical illness polyneuropathy and patients with this condition have not been excluded from the usual care group [2]. The authors reported other outcomes such as duration of mechanical ventilation or ICU length of stay for patients with strength score evaluation, while analysis in all randomized subjects could have been valuable. …