Comparative effects of early physical interventions on preventing intensive care unit-acquired weakness: a systematic review and component network meta-analysis
Journal
BMJ Evidence-Based Medicine
Start Page
bmjebm-2024-113476
ISSN
2515-446X
2515-4478
Date Issued
2025-10-12
Author(s)
Chang, Kai-Mei
Wu, Chia-Rung
Peters, Kath
Ramjan, Lucie
Hou, Wen-Hsuan
Hou, Sen-Kuang
Phuc, Nguyen Thi
Chiu, Hsiao-Yean
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.
Subjects
Critical Care
Rehabillitation
Systematic Reviews as Topic
Publisher
BMJ
Type
journal article