Bedside voluntary and evoked forces evaluation in intensive care unit patients: a narrative review

Abstract

Around one third of intensive care unit (ICU) patients will develop severe neuromuscular alterations, known as intensive care unit-acquired weakness (ICUAW), during their stay. The diagnosis of ICUAW is difficult and often delayed as a result of sedation or delirium. Indeed, the clinical evaluation of both Medical Research Council score and maximal voluntary force (e.g., using handgrip and/or handheld dynamometers), two independent predictors of mortality, can be performed only in awake and cooperative patients. Transcutaneous electrical/magnetic stimulation applied over motor nerves combined with the development of dedicated ergometer have recently been introduced in ICU patients in order to propose an early and non-invasive measurement of evoked force. The aim of this narrative review is to summarize the different tools allowing bedside force evaluation in ICU patients and the related experimental protocols. We suggest that non-invasive electrical and/or magnetic evoked force measurements could be a relevant strategy to characterize muscle weakness in the early phase of ICU and diagnose ICUAW.

Prevalence of self-reported fatigue in intensive care unit survivors 6 months–5 years after discharge

“…The use of specific assessment tools (e.g. ergometers that allow the assessment of evoked muscle forces using transcutaneous electrical/magnetic stimulation), as recently reviewed by our group 44 , could help to build targeted training programs that would reduce the prevalence of fatigue during the days and months that follow hospital discharge.…”

Safety and feasibility of an FES-Cycling based neuromuscular evaluation method in mechanically ventilated patients

“…Non-volitional force measurements have been reported in mechanically ventilated patients. It generally consists of a force transducer and an adjustable platform combined with supramaximal stimuli applied either over a motor nerve or a muscle belly(15). Non-commercial ergometers have been developed which enable recording evoked force in ICU patients in different muscle groups: adductor pollicis(16), ankle dorsiflexors(17) and quadriceps(7).…”

Bedside voluntary and evoked forces evaluation in intensive care unit patients, not only force evaluation: a letter to the Editor

“…We read with great interest the article by Kennouche et al [ 1 ] related to the evaluation of force in intensive care units (ICU). As indicated in their paper, numerous ICU patients develop a specific disease affecting their future quality of life; the so-called intensive care unit-acquired weakness (ICUAW).…”

“…As chronaxie rapidly increases over days in the ICU, we believe that electrodiagnosis could help prescribe optimized electrical stimulation treatments [ 4 ]. However, additional experiments should be conducted to determine the reliability of the different evaluation tools and protocols [ 1 ] and determine the best electrical stimulation rehabilitation procedure, characteristics, or modality (e.g., using belts or functional electrical stimulation) [ 5 ]. As indicated in this narrative review [ 1 ], electrical stimulation is an interesting tool for force evaluation in the ICU.…”

“…However, additional experiments should be conducted to determine the reliability of the different evaluation tools and protocols [ 1 ] and determine the best electrical stimulation rehabilitation procedure, characteristics, or modality (e.g., using belts or functional electrical stimulation) [ 5 ]. As indicated in this narrative review [ 1 ], electrical stimulation is an interesting tool for force evaluation in the ICU. However, electrical stimulation in the ICU should be considered in a more holistic manner as it represents a promising technique for improving patient health both during and after ICU stays.…”