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      Effects of Neuromuscular Electrical Stimulation of the Quadriceps and Diaphragm in Critically Ill Patients: A Pilot Study

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          Abstract

          Background

          Deep and respiratory muscle disorders are commonly observed in critically ill patients. Neuromuscular electrical stimulation (NMES) is an alternative to mobilize and to exercise that does not require active patient participation and can be used on bedridden patients.

          Objective

          Evaluate the effectiveness of the NMES therapy in quadriceps versus diaphragm subjects in mechanical ventilation (MV).

          Methods

          Sixty-seven subjects in MV were included, divided into 3 groups: (a) control group (CG, n=26), (b) stimulation of quadriceps (quadriceps group–QG, n=24), and (c) stimulation of diaphragm (diaphragm group–DG, n=17). The QG and DG patients received consecutive daily electrical stimulation sessions at specific points from the first day of randomization until ICU discharge. Respiratory and peripheral muscle strength, MV time, length of hospitalization, and functional independence score (the Functional Status Score-ICU) were recorded.

          Results

          There were studied n=24 (QG), n=17 (DG), and n=26 (CG) patients. Peripheral muscle strength improved significantly in the QG ( p=0.030). Functional independence at ICU discharge was significantly better in QG ( p=0.013), and the QG presented a better Barthel Index compared to DG and CG ( p=0.0049) and also presented better FSS compared to CG ( p=0.001).

          Conclusions

          Electrical stimulation of quadriceps had best outcomes for peripheral muscle strength compared with controls or electrical stimulation of diaphragm among mechanically ventilated critically ill subjects and promoted functional independence and decreased length of hospitalization.

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          Most cited references41

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          Paresis acquired in the intensive care unit: a prospective multicenter study.

          Bernard De Jonghe, Tarek Sharshar, Jean-Pascal Lefaucheur … (2002)
          Although electrophysiologic and histologic neuromuscular abnormalities are common in intensive care unit (ICU) patients, the clinical incidence of ICU-acquired neuromuscular disorders in patients recovering from severe illness remains unknown. To assess the clinical incidence, risk factors, and outcomes of ICU-acquired paresis (ICUAP) during recovery from critical illness in the ICU and to determine the electrophysiologic and histologic patterns in patients with ICUAP. Prospective cohort study conducted from March 1999 to June 2000. Three medical and 2 surgical ICUs in 4 hospitals in France. All consecutive ICU patients without preexisting neuromuscular disease who underwent mechanical ventilation for 7 or more days were screened daily for awakening. The first day a patient was considered awake was day 1. Patients with severe muscle weakness on day 7 were considered to have ICUAP. Incidence and duration of ICUAP, risk factors for ICUAP, and comparative duration of mechanical ventilation between ICUAP and control patients. Among the 95 patients who achieved satisfactory awakening, the incidence of ICUAP was 25.3% (95% confidence interval [CI], 16.9%-35.2%). All ICUAP patients had a sensorimotor axonopathy, and all patients who underwent a muscle biopsy had specific muscle involvement not related to nerve involvement. The median duration of ICUAP after day 1 was 21 days. Mean (SD) duration of mechanical ventilation after day 1 was significantly longer in patients with ICUAP compared with those without (18.2 [36.3] vs 7.6 [19.2] days; P =.03). Independent predictors of ICUAP were female sex (odds ratio [OR], 4.66; 95% CI, 1.19-18.30), the number of days with dysfunction of 2 or more organs (OR, 1.28; 95% CI, 1.11-1.49), duration of mechanical ventilation (OR, 1.10; 95% CI, 1.00-1.22), and administration of corticosteroids (OR, 14.90; 95% CI, 3.20-69.80) before day 1. Identified using simple bedside clinical criteria, ICUAP was frequent during recovery from critical illness and was associated with a prolonged duration of mechanical ventilation. Our findings suggest an important role of corticosteroids in the development of ICUAP.
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            Acquired weakness, handgrip strength, and mortality in critically ill patients.

            Naeem A. Ali, James O'Brien, Stephen Hoffmann … (2008)
            ICU-acquired paresis (ICUAP) is common in survivors of critical illness. There is significant associated morbidity, including prolonged time on the ventilator and longer hospital stay. However, it is unclear whether ICUAP is independently associated with mortality, as sicker patients are more prone and existing studies have not adjusted for this. To test the hypothesis that ICUAP is independently associated with increased mortality. Secondarily, to determine if handgrip dynamometry is a concise measure of global strength and is independently associated with mortality. A prospective multicenter cohort study was conducted in intensive care units (ICU) of five academic medical centers. Adults requiring at least 5 days of mechanical ventilation without evidence of preexisting neuromuscular disease were followed until awakening and were then examined for strength. We measured global strength and handgrip dynamometry. The primary outcome was in-hospital mortality and secondary outcomes were hospital and ICU-free days, ICU readmission, and recurrent respiratory failure. Subjects with ICUAP (average MRC score of < 4) had longer hospital stays and required mechanical ventilation longer. Handgrip strength was lower in subjects with ICUAP and had good test performance for diagnosing ICUAP. After adjustment for severity of illness, ICUAP was independently associated with hospital mortality (odds ratio [OR], 7.8; 95% confidence interval [CI], 2.4-25.3; P = 0.001). Separately, handgrip strength was independently associated with hospital mortality (OR, 4.5; 95% CI, 1.5-13.6; P = 0.007). ICUAP is independently associated with increased hospital mortality. Handgrip strength is also independently associated with poor hospital outcome and may serve as a simple test to identify ICUAP. Clinical trial registered with www.clinicaltrials.gov (NCT00106665).
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              Early activity is feasible and safe in respiratory failure patients.

              Louise Bezdjian, Jaime Rodriquez, Alan Bailey … (2006)
              To determine whether early activity is feasible and safe in respiratory failure patients. Prospective cohort study. 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 200 mm Hg, systolic blood pressure 200 mm Hg, systolic blood pressure 100 feet at RICU discharge. Early activity is a candidate therapy to prevent or treat the neuromuscular complications of critical illness.
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                Author and article information

                Contributors
                Marcela Aparecida Leite:
                ORCID: http://orcid.org/0000-0001-8953-2799
                Journal
                Journal ID (nlm-ta): Crit Care Res Pract
                Journal ID (iso-abbrev): Crit Care Res Pract
                Journal ID (publisher-id): CCRP
                Title: Critical Care Research and Practice
                Publisher: Hindawi
                ISSN (Print): 2090-1305
                ISSN (Electronic): 2090-1313
                Publication date Collection: 2018
                Publication date (Electronic): 8 July 2018
                Volume: 2018
                Electronic Location Identifier: 4298583
                Affiliations
                1Intensive Care Unit, Western Parana State University Hospital, Avenida Tancredo Neves 3224, Santo Onofre, 85806-470 Cascavel, PR, Brazil
                2Western Parana State University, Rua Universitária 2069, Jardim Universitário, 85819-110 Cascavel, PR, Brazil
                3Department of Medicine, Western Parana State University Hospital, Avenida Tancredo Neves 3224, Santo Onofre, 85806-470 Cascavel, PR, Brazil
                Author notes

                Academic Editor: Antonio Artigas

                Author information
                http://orcid.org/0000-0001-8953-2799
                http://orcid.org/0000-0001-7642-8394
                http://orcid.org/0000-0003-0565-2019
                Article
                DOI: 10.1155/2018/4298583
                PMC ID: 6079614
                PubMed ID: 30123586
                SO-VID: e4ddf16a-9f00-4ad1-a39a-77d6c16faa0b
                Copyright © Copyright © 2018 Marcela Aparecida Leite et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 3 November 2017
                Date revision received : 8 March 2018
                Date accepted : 5 June 2018
                Categories
                Subject: Clinical Study

                ScienceOpen disciplines: Emergency medicine & Trauma
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma

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