Description of Behaviors in Nonverbal Critically Ill Patients With a Traumatic Brain Injury When Exposed to Common Procedures in the Intensive Care Unit: A Pilot Study

Abstract Background Critically ill traumatic brain injury (TBI) patients experience extensive muscle damage during their stay in the intensive care unit. Neuromuscular electrical stimulation (NMES) has been considered a promising treatment to reduce the functional and clinical impacts of this. However, the time needed for NMES to produce effects over the muscles is still unclear. This study primarily aimed to assess the time needed and effects of an NMES protocol on muscle architecture, neuromuscular electrophysiological disorder (NED), and muscle strength, and secondarily, to evaluate the effects on plasma systemic inflammation, catabolic responses, and clinical outcomes. Methods We performed a randomized clinical trial in critically ill TBI patients. The control group received only conventional physiotherapy, while the NMES group additionally underwent daily NMES for 14 days in the lower limb muscles. Participants were assessed at baseline and on days 3, 7, and 14 of their stay in the intensive care unit. The primary outcomes were assessed with muscle ultrasound, neuromuscular electrophysiology, and evoked peak force, and the secondary outcomes with plasma cytokines, matrix metalloproteinases, and clinical outcomes. Results Sixty participants were randomized, and twenty completed the trial from each group. After 14 days, the control group presented a significant reduction in muscle thickness of tibialis anterior and rectus femoris, mean of − 0.33 mm (− 14%) and − 0.49 mm (− 21%), p < 0.0001, respectively, while muscle thickness was preserved in the NMES group. The control group presented a higher incidence of NED: 47% vs. 0% in the NMES group, p < 0.0001, risk ratio of 16, and the NMES group demonstrated an increase in the evoked peak force (2.34 kg/f, p < 0.0001), in contrast to the control group (− 1.55 kg/f, p < 0.0001). The time needed for the NMES protocol to prevent muscle architecture disorders and treat weakness was at least 7 days, and 14 days to treat NED. The secondary outcomes exhibited less precise results, with confidence intervals that spanned worthwhile or trivial effects. Conclusions NMES applied daily for fourteen consecutive days reduced muscle atrophy, the incidence of NED, and muscle weakness in critically ill TBI patients. At least 7 days of NMES were required to elicit the first significant results. Trial registration The trial was registered at ensaiosclinicos.gov.br under protocol RBR-8kdrbz on 17 January 2016.

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Surface Electrostimulation of Acupuncture Points for Sedation of Critically Ill Patients in the Intensive Care Unit – a Pilot Study

Acupuncture in Medicine ◽

10.1136/aim.26.1.1 ◽

2008 ◽

Vol 26 (1) ◽

pp. 1-7 ◽

Cited By ~ 15

Author(s):

Sandeep Nayak ◽

Richard Wenstone ◽

Andy Jones ◽

Jill Nolan ◽

Ann Strong ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trial ◽

Acupuncture Points ◽

Current Frequency ◽

Arterial Blood ◽

Randomised Controlled

Background This is a pilot study to investigate the effects of electrostimulation of acupuncture points on sedation and the dose of sedatives in the Intensive Care Unit. Methods Electrostimulation of acupuncture points was performed on 12 critically ill patients requiring sedation for mechanical ventilation. Electrostimulation was applied by point surface electrodes at LI4, ST36, HT7 and LR3 points for 20 minutes every hour for 12 hours using dense dispersed mode with a current frequency of 10–100Hz and maximum intensity of 10mA. All patients were sedated with propofol and alfentanil as required. The dose of propofol was reduced by 10mg/hour provided the patient remained sedated according to our guidelines. Sedation and analgesia scores, dose of sedative and analgesics drugs, respiratory rate, heart rate, mean arterial blood pressure and compliance with the ventilator were recorded before electrostimulation of acupuncture points, and hourly thereafter for 12 hours. Results There was significant reduction in the median propofol consumption from 145mg/hour (range 30–250) to 15mg/hour (range 0–250) (P<0.05), without any significant change in sedation scores or analgesia scores. The haemodynamic and respiratory variables remained stable. All patients were compliant with the ventilator. Conclusion This pilot study showed significant reduction in the dose of propofol required for sedation in critically ill patients following surface electrostimulation of acupuncture points, without any adverse effects. A randomised controlled trial is warranted.

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Avaliação dos níveis álgicos de pacientes críticos em terapia intensiva, antes, durante e após sessão de fisioterapia respiratória: um estudo piloto

Scientia Medica ◽

10.15448/1980-6108.2017.2.26647 ◽

2017 ◽

Vol 27 (2) ◽

pp. 26647

Author(s):

Nathalya Tamara Costa Fermiano ◽

Odete Mauad Cavenaghi ◽

Juliana Rodrigues Correia ◽

Marcus Vinicius Camargo De Brito ◽

Lucas Lima Ferreira

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pilot Study ◽

Physical Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Self Report ◽

Mechanically Ventilated ◽

Hemodynamic Variables ◽

Chest Physical Therapy

*** Evaluation of pain levels of critically ill intensive care unit patients, before, during and after a session of chest physical therapy: a pilot study ***AIMS: To evaluate pain levels of critically ill patients before, during, and after a chest physical therapy intervention.METHODS: Pilot study conducted at the intensive care unit (ICU) of a teaching hospital. Sedated and mechanically ventilated adult patients aged 18 to 60 years were selected. Sociodemographic, clinical, and hemodynamic data were analyzed, and the Behavioral Pain Scale (BPS) scale was used to assess pain in patients unable to be evaluated by self-report questionnaires.The physical therapy protocol consisted of manual vibrocompression maneuvers in both hemithoraces and of intratracheal aspiration. The hemodynamic variables and the BPS were analyzed in three periods: immediately before, in the fifth minute of intervention, and immediately after physical therapy. The Shapiro-Wilk test and ANOVA were used for the statistical analyses. The level of significance was p ≤0.05.RESULTS: The sample consisted of 22 patients, most of them male, aged 55±23.8 years. Nosocomial pneumonia the most prevalent pathology. There were no significant differences in hemodynamic variables and in pain assessment (p = 0.78) of the critically ill patients in any of the evaluated periods.CONCLUSIONS: In this sample of critically ill and mechanically ventilated ICU patients , no alterations in pain levels were detected during or after chest physical therapy.

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