Is transcutaneous electrical muscle stimulation an alternative for preventing acquired muscle weakness in the pediatric intensive care unit? A scoping review.
BACKGROUND
Transcutaneous electrical muscle stimulation (TEMS) has been progressively used as add-on therapy to reduce muscle atrophy in adults unable to carry out active mobilization in the intensive care unit (ICU). There are no studies addressing TEMS in the pediatric ICU. Therefore, we decided to develop a scoping review, a type of knowledge synthesis, which unlike systematic review, identify gaps in the literature to aid the planning and commissioning of future research.


OBJECTIVE
To provide current perspectives on the application of TEMS for combating pediatric intensive care unit acquired weakness (PICUAW).


METHODS
Online databases were used to identify papers published 2006-2016, from which we selected those used musculoskeletal and cardiorespiratory performance as a primary or secondary outcome variable in participants under 18 years.


RESULTS
The publications reported six clinical trials from 218 outpatients with 9.5 ± 8 years old. There were differences in current modulation and duration of TEMS sessions, with a predominance of high intensity and short duration in which a muscle contraction is triggered. The main use of TEMS was in pediatric neurological disorders. TEMS was more effective when compared with SHAM on spasticity, bone mineral density, disability, and gait. One study regarding spine injury showed improvement in VO2 (P = 0.035) when combined cycling with TEMS.


CONCLUSION
TEMS was an effective and safe treatment for musculoskeletal impairments and cardiorespiratory performance in children with neurological disorders. Although the physiopathology is different in outpatients, an individualized protocol with TEMS might be promising for preventing PICUAW. Its eﬀectiveness, however, deserves further investigation.
['Magalhães|Paulo|P|0000-0002-2224-9291', 'Figueirêdo|Bárbara Bernardo|BB|', 'Vasconcelos|Alanna|A|', 'de Andrade|Érika Marinho|ÉM|', 'Dornelas de Andrade|Armèle|A|', 'Reinaux|Cyda|C|']
D006801:Humans D015278:Intensive Care Units, Pediatric D018908:Muscle Weakness D016032:Randomized Controlled Trials as Topic D004561:Transcutaneous Electric Nerve Stimulation
transcutaneous electrical muscle stimulation intensive care unit intensive care unit acquired weakness neuromuscular dysfunction physical therapy