No abstract

Belt electrode skeletal muscle electrical stimulation can induce muscle contraction of the whole lower body. We examined its efficacy in intensive care. We randomly assigned intensive care unit patients to control and electrical muscle stimulation groups. Early rehabilitation was administered from day 2 and electrical muscle stimulation was administered by belt electrode skeletal muscle electrical stimulation. Femoral muscle volume was evaluated using computed tomography. Ninety-four severely ill patients were included and assigned to 47 control and 47 electrical muscle stimulation groups. Femoral muscle volumes were decreased significantly during day 1 to day 10 in both group, however, electrical muscle stimulation significantly inhibited muscle volume loss. There was a trend to improve the activity of daily living at discharge for electrical muscle stimulation. Belt electrode skeletal muscle electrical stimulation can be introduced from the acute phase of intensive care and inhibit muscle volume loss in critically ill patients. Objectives: Belt electrode skeletal muscle electrical stimulation can induce muscle contraction of the whole lower body. This study examined the efficacy of belt electrode skeletal muscle electrical stimulation on reducing loss of muscle volume in critically ill patients. Methods: Intensive care unit patients were randomly assigned to control and electrical muscle stimulation groups. In both groups, early rehabilitation was administered from day 2 of admission. In the electrical muscle stimulation group, belt electrode skeletal muscle electrical stimulation was administered. Femoral muscle volume was evaluated with computed tomography on days 1 and 10. Results: Ninety-Four severely ill patients were included 47 patients were assigned to each group. Femoral muscle volumes of 16 control and 21 electrical muscle stimulation group patients were measured. For both groups, femoral muscle volume decreased significantly from day 1 to day 10 (p < 0.0001). The mean rate of muscle volume loss was 17.7% (standard deviation (SD) 10.8%) for the control group and 10.4% (SD 10.1%) for the electrical muscle stimulation group (p = 0.04). The score for stair-climbing of Barthel Index was significantly better in the electrical muscle stimulation group 3.9 (SD 4.0) than in the control group 1.5 (1.5) (p = 0.04). Conclusion: Belt electrode skeletal muscle electrical stimulation has the potential to inhibit muscle volume loss in critical care.

Background β‐Hydroxy‐β‐methylbutyrate (HMB), a metabolite of leucine, can strongly induce muscle protein synthesis. We evaluated the efficacy of HMB complex on muscle volume loss during critical care. Methods For this prospective, single‐center, randomized control trial, we created control and HMB groups by random assignment of intensive care unit (ICU) patients for whom enteral nutrition could be performed. From 164 ICU patients, 88 severely ill patients were included and assigned: 43 to control and 45 to HMB. From day 2 after admission, HMB group were administered 3 g HMB, 14 g arginine, and 14 g glutamine daily in addition to standard nutrition therapy. Early rehabilitation with electrical muscle stimulation was started from day 2 in both groups. As a primary outcome, we evaluated femoral muscle volume using computed tomography on days 1 and 10. Results Femoral muscle volumes of 24 control and 26 HMB group participants were analyzed as per protocol. Volumes decreased significantly during days 1–10 (P < 0.0001). Volume loss rates were 14.4 ± 7.1% for control participants and 11.4 ± 8.1% for HMB participants (P = 0.18). In a subgroup of the sequential organ failure assessment scores <10, femoral muscle volume loss was 14.0 ± 6.9% for control participants and 8.7 ± 6.4% for HMB (P = 0.0474). Results of intention‐to‐treat analysis of the 2 groups showed no differences in basic characteristics or outcomes. Conclusions For critically ill patients, HMB complex supplementation from the acute phase of intensive care does not inhibit muscle volume loss.

No abstract

Benzodiazepines are used as first-line treatments for status epilepticus. Fosphenytoin (FPHT) is recommended for second-line therapy; however, intravenous injection of levetiracetam (LEV) may also be effective against status epilepticus. Herein, we compared the efficacy and safety of LEV as a second-line treatment for status epilepticus with FPHT in Japanese patients.Patients with status epilepticus were selected from the database of the Emergency and Critical Care Center of Hitachi General Hospital. The subjects were patients whose status epilepticus was successfully stopped by diazepam, and in whom FPHT or LEV was administered after diazepam. As LEV injections recently became clinically available in Japan, the choice of drug was determined by the treatment period. Thus, 21 patients who were intravenously injected with LEV as a second-line therapy and 42 matched patients (historical controls) who were treated with FPHT (1:2) were selected.The subjects had a mean age of 64.0 ± 2.2 years, and included 48 males and 15 females. The status epilepticus control rates of the FPHT and LEV groups did not differ significantly (81.0% [34/42] vs 85.1% [18/21], respectively; P  =  .69). As for serious adverse events, a reduction in blood pressure was observed in the FPHT group, but not in the LEV group. The oral anticonvulsant switching rates of the 2 groups were similar, but the same-drug switching rates of the FPHT and LEV groups were 8.1% and 77.8%, respectively.The efficacy of intravenous LEV injections after status epilepticus was equivalent to that of FPHT, and the incidence of adverse events was lower in the LEV group. LEV is effective and safe at preventing recurrent seizures after status epilepticus following benzodiazepine treatment.