scholarly journals Neuromuscular electrical stimulation prevents muscle wasting in critically ill comatose patients

2014 ◽  
Vol 128 (6) ◽  
pp. 357-365 ◽  
Author(s):  
Marlou L. Dirks ◽  
Dominique Hansen ◽  
Aimé Van Assche ◽  
Paul Dendale ◽  
Luc J. C. Van Loon
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Electrical Stimulation ◽  
Muscle Fibre ◽  
Critically Ill ◽  
Muscle Wasting ◽  
Neuromuscular Electrical Stimulation ◽  
Patients Experience ◽  
Subsequent Rehabilitation ◽  
Fibre Atrophy

Patients admitted to the intensive care unit (ICU), especially fully sedated patients, experience extensive muscle wasting. Neuromuscular electrical stimulation prevents muscle fibre atrophy in these critically ill comatose patients during 7 days of ICU stay, and possibly improves survival and subsequent rehabilitation.

scholarly journals Neuromuscular electrical stimulation in critically ill traumatic brain injury patients attenuates muscle atrophy, neurophysiological disorders, and weakness: a randomized controlled trial

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Paulo Eugênio Silva ◽  
Rita de Cássia Marqueti ◽  
Karina Livino-de-Carvalho ◽  
Amaro Eduardo Tavares de Araujo ◽  
Joana Castro ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Electrical Stimulation ◽  
Brain Injury ◽  
Critically Ill ◽  
Neuromuscular Electrical Stimulation ◽  
Muscle Thickness ◽  
Control Group ◽  
Secondary Outcomes

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.

Role of sepsis in the development of limb muscle weakness in a porcine intensive care unit model

2012 ◽  
Vol 44 (18) ◽  
pp. 865-877 ◽  
Author(s):  
Sudhakar Aare ◽  
Peter Radell ◽  
Lars I. Eriksson ◽  
Yi-Wen Chen ◽  
Eric P. Hoffman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Heat Shock ◽  
Critically Ill ◽  
Muscle Function ◽  
Muscle Wasting ◽  
Limb Muscle ◽  
Negative Consequences ◽  
Icu Patients ◽  
Biceps Femoris Muscle

Severe muscle wasting and loss of muscle function in critically ill mechanically ventilated intensive care unit (ICU) patients have significant negative consequences on their recovery and rehabilitation that persist long after their hospital discharge; moreover, the underlying mechanisms are unclear. Mechanical ventilation (MV) and immobilization-induced modifications play an important role in these consequences, including endotoxin-induced sepsis. The present study aims to investigate how sepsis aggravates ventilator and immobilization-related limb muscle dysfunction. Hence, biceps femoris muscle gene expression was investigated in pigs exposed to ICU intervention, i.e., immobilization, sedation, and MV, alone or in combination with sepsis, for 5 days. In previous studies, we have shown that ICU intervention alone or in combination with sepsis did not affect muscle fiber size on day 5, but a significant decrease was observed in single fiber maximal force normalized to cross-sectional area (specific force) when sepsis was added to the ICU intervention. According to microarray data, the addition of sepsis to the ICU intervention induced a deregulation of >500 genes, such as an increased expression of genes involved in chemokine activity, kinase activity, and transcriptional regulation. Genes involved in the regulation of the oxidative stress response and cytoskeletal/sarcomeric and heat shock proteins were on the other hand downregulated when sepsis was added to the ICU intervention. Thus, sepsis has a significant negative effect on muscle function in critically ill ICU patients, and chemokine activity and heat shock protein genes are forwarded to play an instrumental role in this specific muscle wasting condition.

scholarly journals Neuromuscular Electrical Stimulation for Intensive Care Unit–Acquired Weakness: Protocol and Methodological Implications for a Randomized, Sham-Controlled, Phase II Trial

2012 ◽  
Vol 92 (12) ◽  
pp. 1564-1579 ◽  
Author(s):  
Michelle E. Kho ◽  
Alexander D. Truong ◽  
Roy G. Brower ◽  
Jeffrey B. Palmer ◽  
Eddy Fan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Electrical Stimulation ◽  
Critical Illness ◽  
Pilot Study ◽  
Muscle Strength ◽  
Phase Ii ◽  
Neuromuscular Electrical Stimulation ◽  
Bed Rest

BackgroundAs the population ages and critical care advances, a growing number of survivors of critical illness will be at risk for intensive care unit (ICU)–acquired weakness. Bed rest, which is common in the ICU, causes adverse effects, including muscle weakness. Consequently, patients need ICU-based interventions focused on the muscular system. Although emerging evidence supports the benefits of early rehabilitation during mechanical ventilation, additional therapies may be beneficial. Neuromuscular electrical stimulation (NMES), which can provide some muscular activity even very early during critical illness, is a promising modality for patients in the ICU.ObjectiveThe objectives of this article are to discuss the implications of bed rest for patients with critical illness, summarize recent studies of early rehabilitation and NMES in the ICU, and describe a protocol for a randomized, phase II pilot study of NMES in patients receiving mechanical ventilation.DesignThe study was a randomized, sham-controlled, concealed, phase II pilot study with caregivers and outcome assessors blinded to the treatment allocation.SettingThe study setting will be a medical ICU.ParticipantsThe study participants will be patients who are receiving mechanical ventilation for 1 day or more, who are expected to stay in the ICU for an additional 2 days or more, and who meet no exclusion criteria.InterventionThe intervention will be NMES (versus a sham [control] intervention) applied to the quadriceps, tibialis anterior, and gastrocnemius muscles for 60 minutes per day.MeasurementsLower-extremity muscle strength at hospital discharge will be the primary outcome measure.LimitationsMuscle strength is a surrogate measure, not a patient-centered outcome. The assessments will not include laboratory, genetic, or histological measures aimed at a mechanistic understanding of NMES. The optimal duration or dose of NMES is unclear.ConclusionsIf NMES is beneficial, the results of the study will help advance research aimed at reducing the burden of muscular weakness and physical disability in survivors of critical illness.

**Poster 352 Early Neuromuscular Electrical Stimulation for Intensive Care Unit Patients: Effect on Muscle Strength and Urinary Nitrogen Excretion

PM&R ◽  
2012 ◽  
Vol 4 ◽  
pp. S310-S310
Author(s):  
Tatjana Paternostro-Sluga ◽  
Michael Hiesmayr ◽  
Dominik Janda ◽  
Stefan Senekowitsch
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Electrical Stimulation ◽  
Muscle Strength ◽  
Neuromuscular Electrical Stimulation ◽  
Nitrogen Excretion ◽  
Urinary Nitrogen Excretion ◽  
Urinary Nitrogen

Efficacy of neuromuscular electrical stimulation in patients with COPD followed in intensive care unit

2015 ◽  
Vol 11 (6) ◽  
pp. 743-750 ◽  
Author(s):  
Olcay Akar ◽  
Ersin Günay ◽  
Sevinc Sarinc Ulasli ◽  
Alper Murat Ulasli ◽  
Emre Kacar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Electrical Stimulation ◽  
Neuromuscular Electrical Stimulation
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