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.

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 Physical Rehabilitation in the ICU

2015 ◽  
Vol 3 (2) ◽  
pp. 63-66
Author(s):  
Md Shah Zaman Khan ◽  
Abul Khair Ahmed Zaman ◽  
AKM Asad Ud Doza
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Bed Rest ◽  
Physical Medicine ◽  
Future Directions ◽  
Physical Impairments ◽  
Icu Discharge ◽  
Physical Deconditioning ◽  
Important Evidence

Intensive care unit (ICU) based rehabilitation has become an important evidence-based component in the management of patients with critical illness. In addition to critical illness, prolonged bed rest and immobility may lead to severe physical deconditioning and loss of muscle mass and muscle weakness. Intensive care unit acquired weakness is associated with increased duration of mechanical ventilation and weaning, longer ICU and hospital stay, and increased mortality. These physical impairments may last for years after ICU discharge. Early Physical Medicine and Rehabilitation (PM&R) interventions in the ICU may attenuate or prevent the weakness and physical impairments occurring during critical illness. This article reviews the effects of prolong bed rest and inactivity, early PM&R interventions, their safety, feasibility, benefits and future directions for early PM&R in the ICU.Bangladesh Crit Care J September 2015; 3 (2): 63-66

scholarly journals Critical illness polyneuromyopathy in septic patients: Is it possible to diagnose it in a bedside clinical examination?

2019 ◽  
Vol 77 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Débora Schmidt ◽  
Ana Cláudia Coelho ◽  
Fernando Nataniel Vieira ◽  
Vitor Félix Torres ◽  
Augusto Savi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Muscle Strength ◽  
Sensitivity And Specificity ◽  
Respiratory Muscle ◽  
Previous History ◽  
Respiratory Muscle Strength ◽  
Peripheral Muscle ◽  
Electrophysiological Examination

ABSTRACT Objective: To determine the sensitivity and specificity of peripheral and respiratory muscle strength tests in diagnosing critical illness polyneuromyopathy (CIPNM), compared with an electrophysiological examination. Methods: Fifty septic patients who required mechanical ventilation for at least five days, and without a previous history of muscle weakness, were included. Peripheral muscle strength was assessed using the Medical Research Council (MRC) score, handgrip strength by dynamometry, and respiratory muscle strength with maximum respiratory pressures. Diagnosis of CIPNM was either confirmed or rejected by an electrophysiological examination. Receiver operating characteristic curve analysis was performed to determine the cut-off values with the best sensitivity (SN) and specificity (SP) of the studied variables in the presence or absence of CIPNM. Results: Patients with CIPNM were older, more critical (APACHE IV/SAPS 3), had a longer hospitalization, required mechanical ventilation for longer, and had a higher rate of intensive care unit readmission. Cutoff values identified CIPNM patients using MRC scores, dynamometry according to sex, maximal expiratory and inspiratory pressures, as well as being confirmed by the electrophysiological examination, with good sensitivity and specificity: < 40 (SN: 0.893; SP: 0.955); < 7 kg (SN: 1; SP: 0.909) for men, < 4 kg (SN: 0.882; SP: 1) for women; < 34 cmH2O (SN: 0.808; SP: 0.909) and > −40 cmH2O (SN: 0.846; SP: 0.909), respectively. Conclusion: The MRC score, dynamometry or maximum respiratory pressures can be used to identify patients with CIPNM at the intensive care bedside assessment. The healthcare professional can choose any of the methods studied to evaluate the patient, based on his experience and the resource available.

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.

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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