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Impacto da eletroestimulação neuromuscular nos programas de reabilitação em pessoas em situação crítica: uma revisão umbrella
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Introdução: A pessoa em situação crítica frequentemente enfrenta limitações físicas, cognitivas e mentais prolongadas, conhecidas como síndrome pós-cuidados intensivos. Uma consequência significativa deste quadro é a fraqueza muscular adquirida em cuidados intensivos, cuja prevenção apresenta benefícios para a pessoa e para o sistema de saúde. A reabilitação é fundamental para evitar as consequências da imobilidade. A estimulação elétrica neuromuscular surge como uma intervenção viável nos programas de reabilitação, embora a sua eficácia ainda não esteja completamente estabelecida. Assim, destaca-se a importância de realizar uma revisão umbrella para analisar o impacto desta intervenção.
Objetivo: Sintetizar o corpo de evidências de revisões sistemáticas que avaliem o impacto da eletroestimulação neuromuscular nos programas de reabilitação em pessoas em situação crítica.
Metodologia: Utilizou-se a metodologia do Joanna Briggs Institute para revisões do tipo umbrella. A pesquisa seguiu a estratégia PICOT, focando em adultos em situação crítica submetidos à eletroestimulação neuromuscular. Foram incluídas revisões sistemáticas, sem restrições linguísticas ou temporais. A pesquisa foi realizada nas bases de dados Medline®, CINAHL®, Scopus®, Scielo®, Web of Science®, Cochrane®, e Sportdiscus®, utilizando termos indexados e livres.
Resultados: Foram incluídas 21 revisões, que revelaram melhorias significativas nos outcomes de força muscular, massa muscular e duração da ventilação mecânica. A força muscular, com 15 estudos analisados, destacou-se como o outcome mais impactante, apresentando resultados positivos em 11 estudos e negativos em 4, refletindo o efeito da intervenção. Quanto à massa muscular, em 7 revisões, 4 estudos mostraram efeitos positivos a favor do grupo de intervenção. Relativamente à duração da ventilação mecânica, de 14 estudos, 7 sugeriram benefícios da eletroestimuação neuromuscular na redução do tempo de ventilação. Indicou uma correlação positiva entre força muscular e duração da ventilação mecânica, especialmente em pessoas em situação crítica submetidas a cirurgias torácicas e abdominais, bem como em indivíduos com doença pulmonar obstrutiva crónica. A eletroestimulação neuromuscular foi considerada segura, com eventos adversos leves ou inexistentes. Contudo, não foram encontradas diferenças estatisticamente significativas nos outcomes de mortalidade, funcionalidade, qualidade de vida ou duração do internamento.
Conclusão: Conclui-se que a eletroestimulação neuromuscular é segura na pessoa em situação crítica, impactando a força muscular, massa muscular e duração da ventilação mecânica, contribuindo assim significativamente para a reabilitação e a qualidade dos cuidados de enfermagem, conforme os padrões de qualidade estabelecidos. Contudo, é necessária a realização de mais estudos com rigor metodológico elevado.
Introduction: Individuals in critical situations often face prolonged physical, cognitive, and mental limitations, known as post-intensive care syndrome. A significant consequence of this condition is muscle weakness acquired in intensive care, the prevention of which presents benefits for both the individual and the healthcare system. Rehabilitation is essential to avoid the consequences of immobility. Neuromuscular electrical stimulation emerges as a viable intervention in rehabilitation programs, although its efficacy has not yet been fully established. Therefore, the importance of conducting an umbrella review to analyze the impact of this intervention is highlighted. Objective: To synthesize the body of evidence from systematic reviews that evaluates the effectiveness of neuromuscular electrical stimulation in critically ill patients. Method of review: The Joanna Briggs Institute methodology for umbrella reviews was used. The research followed the PICOT strategy, focusing on adults in critical conditions undergoing neuromuscular electrical stimulation. Systematic reviews were included without language or time restrictions, excluding studies with populations under 18 years or those not focusing on individuals in critical situations. The search was conducted in the databases Medline®, CINAHL®, Scopus®, Scielo®, Web of Science®, Cochrane®, and Sportdiscus®, using indexed and free-text terms. Results: A total of 21 reviews were included, revealing significant improvements in outcomes related to muscle strength, muscle mass, and duration of mechanical ventilation. Muscle strength, with 15 studies analyzed, emerged as the most impactful outcome, showing positive results in 11 studies and negative results in 4, reflecting the effect of the intervention. Regarding muscle mass, in 7 reviews, 4 studies demonstrated positive effects favoring the intervention group. Concerning the duration of mechanical ventilation, among 14 studies, 7 suggested benefits of neuromuscular electrical stimulation in reducing ventilation time. The analysis indicated a positive correlation between muscle strength and duration of ventilation, particularly in individuals in critical situations undergoing thoracic and abdominal surgeries, as well as in those with chronic obstructive pulmonary disease. Neuromuscular electrical stimulation was deemed safe, with adverse events being mild or nonexistent. However, no statistically significant differences were found in outcomes related to mortality, functionality, quality of life, or length of hospital stay. Conclusion: It is concluded that neuromuscular electrical stimulation is safe for critically ill patients, impacting muscle strength, muscle mass, and the duration of mechanical ventilation, thus significantly contributing to rehabilitation and the quality of nursing care, in accordance with the standards established by the College of Rehabilitation Nursing
Introduction: Individuals in critical situations often face prolonged physical, cognitive, and mental limitations, known as post-intensive care syndrome. A significant consequence of this condition is muscle weakness acquired in intensive care, the prevention of which presents benefits for both the individual and the healthcare system. Rehabilitation is essential to avoid the consequences of immobility. Neuromuscular electrical stimulation emerges as a viable intervention in rehabilitation programs, although its efficacy has not yet been fully established. Therefore, the importance of conducting an umbrella review to analyze the impact of this intervention is highlighted. Objective: To synthesize the body of evidence from systematic reviews that evaluates the effectiveness of neuromuscular electrical stimulation in critically ill patients. Method of review: The Joanna Briggs Institute methodology for umbrella reviews was used. The research followed the PICOT strategy, focusing on adults in critical conditions undergoing neuromuscular electrical stimulation. Systematic reviews were included without language or time restrictions, excluding studies with populations under 18 years or those not focusing on individuals in critical situations. The search was conducted in the databases Medline®, CINAHL®, Scopus®, Scielo®, Web of Science®, Cochrane®, and Sportdiscus®, using indexed and free-text terms. Results: A total of 21 reviews were included, revealing significant improvements in outcomes related to muscle strength, muscle mass, and duration of mechanical ventilation. Muscle strength, with 15 studies analyzed, emerged as the most impactful outcome, showing positive results in 11 studies and negative results in 4, reflecting the effect of the intervention. Regarding muscle mass, in 7 reviews, 4 studies demonstrated positive effects favoring the intervention group. Concerning the duration of mechanical ventilation, among 14 studies, 7 suggested benefits of neuromuscular electrical stimulation in reducing ventilation time. The analysis indicated a positive correlation between muscle strength and duration of ventilation, particularly in individuals in critical situations undergoing thoracic and abdominal surgeries, as well as in those with chronic obstructive pulmonary disease. Neuromuscular electrical stimulation was deemed safe, with adverse events being mild or nonexistent. However, no statistically significant differences were found in outcomes related to mortality, functionality, quality of life, or length of hospital stay. Conclusion: It is concluded that neuromuscular electrical stimulation is safe for critically ill patients, impacting muscle strength, muscle mass, and the duration of mechanical ventilation, thus significantly contributing to rehabilitation and the quality of nursing care, in accordance with the standards established by the College of Rehabilitation Nursing
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Fraqueza Muscular Eletroestimulação Neuromuscular Doente crítico Reabilitação