***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Critically ill patients are characterized by increased loss of muscle mass , partially attributed to sepsis and multiple organ failure , as well as immobilization . Recent studies have shown that electrical muscle stimulation ( EMS ) may be an alternative to active exercise in chronic obstructive pulmonary disease ( COPD ) and chronic heart failure ( CHF ) patients with myopathy . The aim of our study was to investigate the EMS effects on muscle mass preservation of critically ill patients with the use of ultrasonography ( US ) . Methods Forty-nine critically ill patients ( age : 59 ± 21 years ) with an APACHE II admission score ≥13 were r and omly assigned after stratification upon admission to receive daily EMS sessions of both lower extremities ( EMS-group ) or to the control group ( control group ) . Muscle mass was evaluated with US , by measuring the cross sectional diameter ( CSD ) of the vastus intermedius and the rectus femoris of the quadriceps muscle . Results Twenty-six patients were finally evaluated . Right rectus femoris and right vastus intermedius CSD decreased in both groups ( EMS group : from 1.42 ± 0.48 to 1.31 ± 0.45 cm , P = 0.001 control group : from 1.59 ± 0.53 to 1.37 ± 0.5 cm , P = 0.002 ; EMS group : from 0.91 ± 0.39 to 0.81 ± 0.38 cm , P = 0.001 control group : from 1.40 ± 0.64 to 1.11 ± 0.56 cm , P = 0.004 , respectively ) . However , the CSD of the right rectus femoris decreased significantly less in the EMS group ( -0.11 ± 0.06 cm , -8 ± 3.9 % ) as compared to the control group ( -0.21 ± 0.10 cm , -13.9 ± 6.4 % ; P < 0.05 ) and the CSD of the right vastus intermedius decreased significantly less in the EMS group ( -0.10 ± 0.05 cm , -12.5 ± 7.4 % ) as compared to the control group ( -0.29 ± 0.28 cm , -21.5 ± 15.3 % ; P < 0.05 ) . Conclusions EMS is well tolerated and seems to preserve the muscle mass of critically ill patients . The potential use of EMS as a preventive and rehabilitation tool in ICU patients with polyneuromyopathy needs to be further investigated . Trial Registration clinical trials.gov : Objective : To determine whether early activity is feasible and safe in respiratory failure patients . Design : Prospect i ve cohort study . Setting : From June 1 , 2003 , through December 31 , 2003 , we assessed safety and feasibility of early activity in all consecutive respiratory failure patients who required mechanical ventilation for > 4 days admitted to our respiratory intensive care unit ( RICU ) . A majority of patients were treated in another intensive care unit ( ICU ) before RICU admission . We excluded patients who required mechanical ventilation for ≤4 days . Patients : Eight‐bed RICU at LDS Hospital . Interventions : We assessed patients for early activity as part of routine respiratory ICU care . We prospect ively recorded activity events and adverse events . We defined three activity events as sit on bed , sit in chair , and ambulate . We defined six activity‐related adverse events as fall to knees , tube removal , systolic blood pressure > 200 mm Hg , systolic blood pressure < 90 mm Hg , oxygen desaturation < 80 % , and extubation . Measurements and Main Results : During the study period , we conducted a total of 1,449 activity events in 103 patients . The activity events included 233 ( 16 % ) sit on bed , 454 ( 31 % ) sit in chair , and 762 ( 53 % ) ambulate . In patients with an endotracheal tube in place , there were a total of 593 activity events , of which 249 ( 42 % ) were ambulation . There were < 1 % activity‐related adverse events , including fall to the knees without injury , feeding tube removal , systolic blood pressure > 200 mm Hg , systolic blood pressure < 90 mm Hg , and desaturation < 80 % . No patient was extubated during activity . Conclusions : We conclude that early activity is feasible and safe in respiratory failure patients . A majority of survivors ( 69 % ) were able to ambulate > 100 feet at RICU discharge . Early activity is a c and i date therapy to prevent or treat the neuromuscular complications of critical illness Purpose : The purpose of this review is to evaluate the literature related to mobilization of the critically ill patient with an emphasis on functional outcomes and patient safety . Methods : We search ed the electronic data bases of PubMed , CINAHL , Medline ( Ovid ) , and The Cochrane Library for a period spanning 2000‐2011 . Articles used in this review included r and omized and nonr and omized clinical trials , prospect i ve and retrospective analyses , and case series in peer review ed journals . Sackett 's Levels of Evidence were used to classify the current literature to evaluate the strength of the outcomes reported . Results : Fifteen studies met inclusion criteria and were review ed . According to Sackett 's Levels of Evidence , 9 studies were level 4 evidence , one study was level 3 , 4 studies were level 2 , and one study was level one evidence . Ten studies pertained to patient safety/feasibility and 10 studies pertained to functional outcomes with 5 fitting into both categories . Conclusion : A search of the scientific literature revealed a limited number of studies that examined the mobilization of critically ill patients in the intensive care unit . However , literature that does exist supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes Introduction Critical illness polyneuromyopathy ( CIPNM ) is a common complication of critical illness presenting with muscle weakness and is associated with increased duration of mechanical ventilation and weaning period . No preventive tool and no specific treatment have been proposed so far for CIPNM . Electrical muscle stimulation ( EMS ) has been shown to be beneficial in patients with severe chronic heart failure and chronic obstructive pulmonary disease . Aim of our study was to assess the efficacy of EMS in preventing CIPNM in critically ill patients . Methods One hundred and forty consecutive critically ill patients with an APACHE II score ≥ 13 were r and omly assigned after stratification to the EMS group ( n = 68 ) ( age:61 ± 19 years ) ( APACHE II:18 ± 4 , SOFA:9 ± 3 ) or to the control group ( n = 72 ) ( age:58 ± 18 years ) ( APACHE II:18 ± 5 , SOFA:9 ± 3 ) . Patients of the EMS group received daily EMS sessions . CIPNM was diagnosed clinical ly with the medical research council ( MRC ) scale for muscle strength ( maximum score 60 , < 48/60 cut off for diagnosis ) by two unblinded independent investigators . Duration of weaning from mechanical ventilation and intensive care unit ( ICU ) stay were recorded . Results Fifty two patients could be finally evaluated with MRC ; 24 in the EMS group and 28 in the control group . CIPNM was diagnosed in 3 patients in the EMS group as compared to 11 patients in the control group ( OR = 0.22 ; CI : 0.05 to 0.92 , P = 0.04 ) . The MRC score was significantly higher in patients of the EMS group as compared to the control group [ 58 ( 33 to 60 ) vs. 52 ( 2 to 60 ) respectively , median ( range ) , P = 0.04 ) . The weaning period was statistically significantly shorter in patients of the EMS group vs. the control group [ 1 ( 0 to 10 ) days vs. 3 ( 0 to 44 ) days , respectively , median ( range ) , P = 0.003 ] . Conclusions This study suggests that daily EMS sessions prevent the development of CIPNM in critically ill patients and also result in shorter duration of weaning . Further studies should evaluate which patients benefit more from EMS and explore the EMS characteristics most appropriate for preventing CIPNM.Trial Registration Number Clinical Trials.gov Purpose . This is a secondary analysis of previously published data to investigate the effects of electrical muscle stimulation ( EMS ) on strength of various muscle groups in critically ill patients . Methods . One hundred forty-two consecutive patients , with APACHE II score ≥ 13 , were r and omly assigned to the EMS or the control group . EMS sessions were applied daily on vastus lateralis , vastus medialis , and peroneus longus of both lower extremities . Various muscle groups were evaluated with the Medical Research Council ( MRC ) scale for muscle strength . H and grip strength assessment was also employed . Results . Twenty four patients in the EMS group and 28 patients in the control group were finally evaluated .  EMS patients achieved higher MRC scores than controls ( P ≤ 0.05 ) in wrist flexion , hip flexion , knee extension , and ankle dorsiflexion . Collectively , the EMS group performed higher ( P < 0.01 ) in the legs and overall . H and grip strength correlated ( P ≤ 0.01 ) with the upper and lower extremities ' muscle strength and the overall MRC scores . Conclusions . EMS has beneficial effects on the strength of critically ill patients mainly affecting muscle groups stimulated , while it may also affect muscle groups not involved presenting itself as a potential effective means of muscle strength preservation and early mobilization in this patient population OBJECTIVE It is known that patients in the intensive care unit show an enormous loss of muscle mass . Neuromuscular electrical stimulation is effective in enhancing strength and endurance in immobilized patients . The aim of this study was to evaluate the effects of neuromuscular electrical stimulation on muscle layer thickness of knee extensor muscles in intensive care unit patients . DESIGN R and omized , controlled , double-blind , pilot trial . PATIENTS Thirty-three patients , male to female ratio 26:7 , mean age 55 years ( st and ard deviation 15 ) . METHODS After enrolment in the study , intensive care unit patients ( main diagnoses : polytrauma , cardiovascular diseases , transplantation , pneumonia , cancer ) were stratified ( based on the length of their stay in hospital ) into 2 groups : 17 acute patients ( < 7 days ) and 16 long-term patients ( > 14 days ) . Both groups were r and omized to a stimulation group or a sham-stimulation group . Neuromuscular electrical stimulation was applied to knee extensor muscles for a period of 4 weeks ( session time 30 - 60 minutes , 5 days/week ) . Ultrasound measurements were performed before and after the stimulation period to quantify muscle layer thickness of knee extensor muscles . RESULTS Only stimulated long-term patients ( + 4.9 % ) showed a significant ( p = 0.013 ) increase in muscle layer thickness compared with sham-stimulated patients ( -3.2 % ) . CONCLUSION Neuromuscular electrical stimulation appears to be a useful adjunct to revert muscle wasting in intensive care unit long-term patients ; however , larger studies with a larger sample size are needed to confirm these promising , but preliminary , results OBJECTIVE To analyze the outcomes achieved by motor physical therapy in critically ill patients admitted to intensive care units . METHODS A systematic literature review was performed , and clinical trials published between 2002 and 2011 were included in the study . The search involved the LILACS , SciELO , MedLine , EMBASE and Cochrane data bases , using the keywords " intensive care unit " , " physiotherapy " , " physical therapy " , " mobility " , " mobilization " and " r and omized controlled trials . " Two research ers screened the articles independently and included works that addressed the effect of physical therapy on critically ill patients . RESULTS From an initial analysis of 67 potentially relevant articles , only 8 met the selection criteria and addressed the outcomes of  electrostimulation , cycle ergometry and kinesiotherapy techniques .  The sample sizes ranged from 8 to 101 subjects , with mean ages between 52 and 79 years . All patients were undergoing invasive mechanical ventilation . Among the analyzed articles , 6 reported significant benefits of motor physical therapy , such as improvement in peripheral muscle strength , respiratory capacity and functionality , in critically ill patients . CONCLUSION With this systematic review , it is possible to conclude that motor physical therapy is a feasible and safe therapy for critically ill patients and can minimize the deleterious effects of prolonged immobilization . Approaches involving electrostimulation , cycle ergometry and kinesiotherapy showed positive responses in patients under intensive care . Available evidence regarding the impact of motor physical therapy on length of stay in intensive care units and on mortality is still scarce , and further study in this area is warranted Introduction Intensive care-acquired weakness is a common problem , leads to significant impairment in physical functioning and muscle strength , and is prevalent in individuals with sepsis . Early rehabilitation has been shown to be safe and feasible ; however , commencement is often delayed due to a patient 's inability to co-operate . An intervention that begins early in an intensive care unit ( ICU ) admission without the need for patient volition may be beneficial in attenuating muscle wasting . The eRiCC ( early rehabilitation in critical care ) trial will investigate the effectiveness of functional electrical stimulation-assisted cycling and cycling alone , compared to st and ard care , in individuals with sepsis 
    Output:
    
Electrical muscle stimulation appears to preserve muscle mass and strength in long-stay participants and in those with less acuity .
Electrical muscle stimulation is a promising intervention ; however , there is conflicting evidence for its effectiveness when administered acutely .