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NMES adoption

NMES is included in the clinical guidelines as a tool for physical therapy in the intensive care unit (Intensive Care Med. 2008;34(7):1188-1199), however this technology is not adopted. So my question is the following: why do you think the NMES technology is not adopted in intensive care units as a tool for early rehab and muscle preservation? thx for your feedback

Oussama Hassan

3 years ago

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Prof Gad Alon
Prof Gad Alon

As one of the researchers who is currently involved in 2 studies using FES in critical care units at the University of Maryland Medical Center in Baltimore, I can share with you several observations explaining why it is not consider standard of care option despite the current evidence of effectiveness.

  1. Most patients only stay 1-2 week before moving to other locations and during the stay they are bombarded with numerous testing and treatments. If setting up the FES takes 10-15 min therapist do not have the time to set it up. In our research it only take 1-2 min.
  2. Current evidence is strong that NMES/FES can significantly slow down (not prevent) muscle atrophy during 2 weeks of daily stimulation but if we can not demonstrate that it helped to discharge the patient faster from the ICU (which will save a lot of money) we will not be able to justify the added cost of the FES intervention. I hope our studies will show such saving and that maybe a turning point in favor of FES.
  3. To date, FES is offered very sporadically and generally for very short 4-6 weeks while most patients are likely to need it for much longer time, namely for most patients throughout the continuum of care. To achieve it all FES should be designed as wearable, wireless system that can be applied anywhere ICU, rehab centers, outpatients, and at home

Dr Rennie, Do you mean the EMS is adopted by centers where clinical trials were conducted? and why do you think the technology is not adopted by other medical centers?

Prof Bellew, thx for your feedback thx

Last updated 3 years ago

Prof James Bellew
Prof James Bellew

You ask a great question, "why do you think the NMES technology is not adopted in intensive care units as a tool for early rehab and muscle preservation?" There may be several answers to this but the most likely answer is that they are not aware of the evidence for the use of NMES in intensive care and critically ill populations. Using the reference cited by Dr. Rennie in the previous reply, you will now be able to provide such evidence. Good luck, Jim

Dr Sandy Rennie
Dr Sandy Rennie

Hello Oussama.

We recently published a special issue og Physiotherapy Canada entitled Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice. Nussbaum et al. Physiotherapy Canada 69, Special Issue, 2017. In that review Section 3 deals with Critical Illness and Advanced Disease States (p. 49-59) and there are many references where NMES is used in ICU. Hopefully you will find what you are looking for to further answer your question.

Regards, Sandy

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