Effects of electrical muscle stimulation early in the quadriceps and tibialis anterior muscle of critically ill patients

Background: Electrical muscle stimulation (EMS) is applied to critically ill patients in order to improve their muscle strength, thereby preventing hypotrophy and promoting functional recovery. Aims and objectives: To assess the effects of early EMS in the quadriceps and anterior tibialis muscle strength and in the range of movement of the ankle joint in critical patients. Methods: This is a prospective randomized clinical trial comprising 11 patients with a good cardiovascular and respiratory status under mechanical ventilation for up to 48 hours. Before and after EMS the thigh and leg circumference in both lower limbs and the goniometry of tibiotarsal joint were measured. EMS was applied to just one side of the quadriceps and anterior tibialis muscles until the patient reached level 4 of strength on the Oxford scale. Results: Compared with the electrostimulated limb, a diferent dorsiflexion of the control limb was observed (96.2 ± 24.9 vs 119.9 ± 14.1°; p = 0.01). A reduction of the 10 cm over the lateral malleolus perimetry control limb was observed as compared to the electrostimulated one (24.7 ± 3.1 vs 26.4 ± 4.0 cm, p = 0.03). Conclusions: The use of early EMS in the quadriceps and anterior tibialis muscles was not enough to preserve muscle mass, but it can be applied as a preventive tool against the stance flexion of the ankle joint in critical patients.