Daily use of a muscle pump activator device reduces duration of hospitalization and improves early graft outcomes post-kidney transplantation: A randomized controlled trial

Abstract

Introduction: Kidney and simultaneous pancreas-kidney (SPK) transplant recipients can have prolonged postoperative hospitalization due to edema. Thrombo-embolic-deterrent (TED) stockings with intermittent pneumatic compression devices (TED+IPC) have been used to improve venous return during the perioperative period. The objective of this trial was to evaluate the effects of TED+IPC vs. muscle pump activator (MPA) devices on factors that could reduce postoperative complications and duration of hospitalization.
 Methods: In this single-center, prospective, randomized, controlled trial, 221 kidney and SPK transplant recipients were randomized to either wearing TED+IPC or MPA for six days postoperatively. Groups were compared with respect to postoperative urine output, lower limb edema, weight, days in hospital, mobility, serum creatinine, delayed graft function, need for dialysis, and lower extremity blood flow.
 Results: Patients in the MPA group had significantly higher urine output and less increase in mid-calf leg circumference and weight gain compared to the TED+IPC group (p=0.003, p=0.001, and p=0.003, respectively). The MPA group also experienced shorter hospitalization (p=0.038), higher femoral vein velocity (p=0.001), and took more steps (p=0.009). Incidence of delayed graft function (p=0.72) and number of dialysis runs (p=0.39) was not different between study groups. Subgroup analysis of primary endpoints in donation after cardiac death recipients and SPK recipients did not yield any significance between the study arms.
 Conclusions: Postoperative use of the MPA device increases urine output, decreases leg edema, minimizes weight gain, and decreases duration of hospitalization after kidney transplantation. A larger and longer-term trial is needed to evaluate the impact on graft function.

Efficacy of neuromuscular electrical stimulation for thoracic and abdominal surgery: A systematic review and meta-analysis

“…The length of the intervention spanned 5 days to 4 weeks, and the frequency of the intervention ranged from three times per week to every day. Seven studies involved stimulation of one muscle [ 30 , 31 , 35 , 39 , 43 , 45 , 46 ], nine involved stimulations of multiple muscles [ 32 – 34 , 36 – 38 , 41 , 42 , 44 ], one involved stimulation of the common peroneal nerve [ 47 ], and one involved stimulation of the lower limb [ 41 ]. The most common stimulation site was the quadriceps.…”

“…Moreover, The evidence suggests that NMES slightly reduced the length of hospital stay in other surgeries (one study [ 47 ], 221 participants): MD, −1.21, 95% CI −2.35 −0.07; low certainty evidence ( Fig 5 and Table 5 ).…”

“…After screening, we excluded 17 studies due to incorrect population, nine for incorrect intervention, and one for incorrect design (S2 Table ). In the qualitative synthesis, we identified 18 RCTs [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] that met all the eligibility criteria (Fig 1 and Table 1). The 18 RCTs included 915 patients who underwent thoracic and abdominal surgeries and were postoperatively treated with NMES.…”

“…Out of the 18 RCTs, four [33,36,41,44] were only protocol registrations and did not have outcome data. Overall, there were 10 studies [30][31][32][33][34][35][36][37][38][39] in cardiovascular surgery, two [40,41] in pulmonary surgery, five [42][43][44][45][46] in digestive system surgery, and one [47] in other surgeries. Cardiovascular surgery studies included aortic valve replacement, coronary artery bypass grafting, heart transplantation, mitral valve replacement, mitral valve reconstruction, or tricuspid valve reconstruction.…”

“…one muscle [30,31,35,39,43,45,46], nine involved stimulations of multiple muscles [32-34, 36-38, 41, 42, 44], one involved stimulation of the common peroneal nerve [47], and one involved stimulation of the lower limb [41]. The most common stimulation site was the quadriceps.…”