Objective: To evaluate and compare the effects of neuromuscular electrical stimulation combined with conventional physical therapy on muscle thickness in critically ill patients. Design: Double-blind, randomized controlled trial. Patients: Twenty-five patients participated in the study. Methods: Patients on mechanical ventilation for 24-48 h were randomized to an intervention group (neuromuscular electrical stimulation + conventional physical therapy) or a conventional group (sham neuromuscular electrical stimulation + conventional physical therapy). Primary outcome was thickness of the rectus abdominis and chest muscles, determined on cross-sectional ultrasound images before and after the intervention. Results: Eleven patients were included in the intervention group and 14 in the conventional group. After neuromuscular electrical stimulation, rectus abdominis muscle thickness and chest muscle thickness were preserved in the intervention group, whereas there was a significant reduction in thickness in the conventional group, with a significant difference between groups. There was a significant difference between groups in length of stay in the intensive care unit, with shorter length of stay in the intervention group. Conclusion: There was no change in rectus abdominis and chest muscle thickness in the intervention group. A significant decrease was found in these measures in the conventional group.

BackgroundPatients in Intensive Care Units (ICU) are often exposed to prolonged immobilization which, in turn, plays an important role in neuromuscular complications. Exercise with a cycle ergometer is a treatment option that can be used to improve the rehabilitation of patients on mechanical ventilation (MV) in order to minimize the harmful effects of immobility.Methods/DesignA single-blind randomized controlled trial (the MoVe ICU study) will be conducted to evaluate and compare the effects of early rehabilitation using a bedside cycle ergometer with conventional physical therapy on the muscle morphology of the knee extensors and diaphragm in critical ill patients receiving MV. A total of 28 adult patients will be recruited for this study from among those admitted to the intensive care department at the Hospital de Clínicas de Porto Alegre. Eligible patients will be treated with MV from a period of 24 to 48 h, will have spent maximum of 1 week in hospital and will not exhibit any characteristics restricting lower extremity mobility. These subjects will be randomized to receive either conventional physiotherapy or conventional physiotherapy with an additional cycle ergometer intervention. The intervention will be administered passively for 20 min, at 20 revolutions per minute (rpm), once per day, 7 days a week, throughout the time the patients remain on MV. Outcomes will be cross-sectional quadriceps thickness, length of fascicle, pennation angle of fascicles, thickness of vastus lateralis muscle, diaphragm thickness and excursion of critical ICU patients on MV measured with ultrasound.DiscussionThe MoVe-ICU study will be the first randomized controlled trial to test the hypothesis that early rehabilitation with a passive cycle ergometer can preserve the morphology of knee extensors and diaphragm in critical patients on MV in ICUs.Trial registrationNCT02300662 (25 November 2014).

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Abstract.[Purpose] To analyze the effects of neuromuscular electrical stimulation (NMES) applied to the abdominal muscles of patients with COPD.[Subjects] A total of 22 patients in group A, mean age of 68.2 ± 6.4 years and in group B, 71.2 ± 10.1 years.[Methods] Randomized clinical trial. Patients with COPD were randomly an evenly divided into two groups: group A (NMES + conventional therapy) and group B (conventional physiotherapy) and respiratory muscle strength was measured by pressure manometry before and after the end of the experimental protocols.[Results] Maximum inspiratory pressure before and after the intervention of group A was −64 (44-74) cm H2O, respectively, and −68 (56-96) cmH2O, and in group B, −52 (46-92) cm H2O and −60 (50-72) cmH2O. Maximum expiratory pressure of group A was 84 (72-92) cmH2O and 112 (94-120), respectively, and in group B, 76 (60-100) cmH2O and 84 (60-108) cmH2O.[Conclusion] The results indicate that expiratory muscle training with Russian current together with conventional physical therapy during hospitalization improves the respiratory muscle strength of patients with COPD.