Effect of neuromuscular electrical stimulation on the recovery of people with COVID-19 admitted to the intensive care unit: A narrative review.
Louise C Burgess, Lalitha Venugopalan, James Badger and 7 others
PMID 33634830WHAT IT FOUND
NMES may slow muscle wasting and help wean ventilated patients, but evidence for building strength is mixed.
It is safe for most ICU patients, including those with pacemakers, provided electrodes are placed carefully. Use it alongside active movement, not just as a passive substitute.
Key findings
01NMES reduces the rate of muscle volume loss in ICU patients, but does not necessarily increase muscle mass during short stays.
02NMES applied to abdominal muscles during exhalation shortened the duration of mechanical ventilation and ICU stay compared to sensory-level stimulation.
03NMES is considered safe for patients with pacemakers or implanted defibrillators when lower limb stimulation is used, though monitoring is advised.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, meaning it may not capture all relevant evidence and is subject to author selection bias. Most included studies had short durations (5-14 days), so long-term effects of NMES on functional recovery are unknown. There is significant variability in NMES protocols (frequency, duration, placement) across studies, making it difficult to recommend a single optimal dose. The evidence base is largely derived from general ICU populations or COPD patients, not specifically from patients with COVID-19, though the review applies it to that context. Few studies reported on patient-reported outcomes or quality of life, limiting understanding of the clinical benefit beyond physiological measures.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume NMES alone will restore muscle strength or functional independence. The evidence suggests it primarily slows muscle loss during immobilization. To achieve strengthening, NMES must be combined with active exercise or volitional contraction, and continued after discharge.