Electrical muscle stimulation for prevention of critical illness polyneuropathy

showing that electrical muscle stimulation (EMS) reduced the frequency of critical illness polyneuropathy in intensive care unit (ICU) patients [1] . Th e authors stated that an intention-to-treat analysis was used. One hundred and forty patients were randomized to electrical stimulation or to usual care. Measurement of the main outcome could only be performed in cooperating patients surviv ing after awakening. Th us, 39 patients (57%) and 44 patients (61%) who died or who had impaired cognitive state were excluded from analysis in each arm. Data from fi ve out of 29 subjects on the intervention arm were also excluded from the fi nal analysis because of neuro muscu lar blocker use (n = 3) or a lack of electrical stimulation during the ICU stay (n = 2). Th e latter probably induced a selection bias, as subjects receiving neuromuscular blockers have increased risk of critical illness polyneuropathy and patients with this condition have not been excluded from the usual care group [2] . Th e authors reported other outcomes such as duration of mechanical ventilation or ICU length of stay for patients with strength score evaluation, while analysis in all randomized subjects could have been valuable. Finally, reported strength scores represented the addition of upper and lower extremities, while stimulation was only applied to the latter. As systemic eff ects of EMS have not been defi nitely established in this setting, it would have been interesting to compare the strength of muscles where the intervention was tested.