Comparative effects of early physical interventions on preventing intensive care unit-acquired weakness: a systematic review and component network meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: SEM+NMES: OR 0.03; SEM alone: OR 0.09; NMES alone: OR 0.12

• Primary Outcome: Incidence of ICU-acquired weakness

• Nnt Or Sensitivity: Component analysis: SEM OR 0.14 (95% CI 0.02-0.83), NMES OR 0.22 (95% CI 0.09-0.52)

• Confidence Interval: SEM+NMES: 95% CI 0.00-0.42; SEM alone: 95% CI 0.01-0.97; NMES alone: 95% CI 0.03-0.44

Clinical Application

Requires trained physiotherapy staff and NMES equipment; implementation depends on ICU resources and protocols Aligns with Australian and New Zealand Intensive Care Society (ANZICS) guidelines for early mobilisation; may require additional PBS consideration for NMES equipment funding Adult critically ill patients requiring mechanical ventilation or ICU admission in Australian intensive care units

Abstract

OBJECTIVE: To compare the effects of early physical interventions on the prevention of intensive care unit-acquired weakness (ICUAW) and the improvement of relevant clinical outcomes in patients with critical illness. METHODS: We systematically searched the Web of Science, PubMed, Embase and the Cochrane Central Register of Controlled Trials from their inception until 20 August 2024, to identify randomised controlled trials (RCTs) enrolling patients ≥18 years old and implementing early physical intervention that commenced at any time point during mechanical ventilation (MV) use or within 7 days after intensive care unit (ICU) admission for review. We synthesised data using a random-effects model and analysed through network meta-analysis (NMA) and component network meta-analysis (CNMA). MAIN OUTCOME MEASURES: Primary outcome is the incidence of ICUAW. Secondary outcomes included Medical Research Council sum score, length of stay in the ICU or hospital, duration of MV and mortality rates in the ICU or hospital. RESULTS: Our analyses included 63 RCTs involving 24 treatments and eight components. The NMA results revealed systematic early mobilisation (SEM) combined with neuromuscular electrical stimulation (NMES), SEM alone and NMES alone may lead to a moderate to large reduction in the incidence of ICUAW (odds ratios [ORs]=0.03, 0.09 and 0.12, 95% confidence intervals [CIs]=0.00 to 0.42, 0.01 to 0.97 and 0.03 to 0.44, respectively) and improved relevant clinical outcomes compared with routine care. The CNMA results further indicated that SEM (OR=0.14, 95% CI=0.02 to 0.83) and NMES (OR=0.22, 95% CI=0.09 to 0.52) effectively mitigated the ICUAW incidence. CONCLUSIONS: SEM and NMES are optimal interventions for preventing ICUAW. Healthcare providers in ICUs should implement early mobilisation with structured protocols and patient assessments or apply NMES to specific muscle groups to prevent ICUAW in critically ill patients and improve relevant clinical outcomes. PROSPERO REGISTRATION NUMBER: CRD42024581173.

References

1. 1.Chang, K. M., Tu, Y. K., Wu, C. R., Peters, K., Ramjan, L., Hou, W. H., Hou, S. K., Phuc, N. T., & Chiu, H. Y. (2024). Comparative effects of early physical interventions on preventing intensive care unit-acquired weakness: a systematic review and component network meta-analysis. BMJ Evidence-Based Medicine. https://doi.org/10.1136/bmjebm-2024-113476