Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study

Abstract

IntroductionCritically ill patients are characterized by increased loss of muscle mass, partially attributed to sepsis and multiple organ failure, as well as immobilization. Recent studies have shown that electrical muscle stimulation (EMS) may be an alternative to active exercise in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients with myopathy. The aim of our study was to investigate the EMS effects on muscle mass preservation of critically ill patients with the use of ultrasonography (US).MethodsForty-nine critically ill patients (age: 59 ± 21 years) with an APACHE II admission score ≥13 were randomly assigned after stratification upon admission to receive daily EMS sessions of both lower extremities (EMS-group) or to the control group (control group). Muscle mass was evaluated with US, by measuring the cross sectional diameter (CSD) of the vastus intermedius and the rectus femoris of the quadriceps muscle.ResultsTwenty-six patients were finally evaluated. Right rectus femoris and right vastus intermedius CSD decreased in both groups (EMS group: from 1.42 ± 0.48 to 1.31 ± 0.45 cm, P = 0.001 control group: from 1.59 ± 0.53 to 1.37 ± 0.5 cm, P = 0.002; EMS group: from 0.91 ± 0.39 to 0.81 ± 0.38 cm, P = 0.001 control group: from 1.40 ± 0.64 to 1.11 ± 0.56 cm, P = 0.004, respectively). However, the CSD of the right rectus femoris decreased significantly less in the EMS group (-0.11 ± 0.06 cm, -8 ± 3.9%) as compared to the control group (-0.21 ± 0.10 cm, -13.9 ± 6.4%; P < 0.05) and the CSD of the right vastus intermedius decreased significantly less in the EMS group (-0.10 ± 0.05 cm, -12.5 ± 7.4%) as compared to the control group (-0.29 ± 0.28 cm, -21.5 ± 15.3%; P < 0.05).ConclusionsEMS is well tolerated and seems to preserve the muscle mass of critically ill patients. The potential use of EMS as a preventive and rehabilitation tool in ICU patients with polyneuromyopathy needs to be further investigated.Trial Registrationclinicaltrials.gov: NCT00882830

Quadriceps wasting and physical inactivity in patients with COPD

“…CT and MRI modalities have been shown to have an advantage over ultrasound in serial measurements, which is probably to relate to use of bony landmarks for measurement position in comparison to the use of surface anatomy. However, a randomised controlled trial using electrical muscle stimulation to reduce muscle wasting in the intensive care unit setting has shown that ultrasound measurement of the quadriceps has strong potential as a bedside imaging modality for identifying serial changes in muscle bulk following intervention [41].…”

Rehabilitation in the intensive care unit: electrical stimulation of skeletal muscles

“…Несколько исследований группы греческих авторов [25][26][27] проводились у пациентов многопрофильного ОРИТ со значением оценки по шкале APACHE II более 13 баллов. В первом оценивали толщину мышечного слоя мускулатуры бедра после курса ЭСМ, который начинали со 2-х суток пребывания в ОРИТ до момента перевода в профильное отделение.…”

“…В первом оценивали толщину мышечного слоя мускулатуры бедра после курса ЭСМ, который начинали со 2-х суток пребывания в ОРИТ до момента перевода в профильное отделение. У всех пациентов развивалась мы-шечная атрофия, однако в группе ЭСМ ее выраженность была значительно меньше как в абсолютных цифрах (-0,11±0,06 см против -0,21±0,10 см; p=0,009), так и в от-носительных значениях (-8,0±3,9% против -13,9±6,4%; p=0,005) [25]. В работе C. Routsi и соавт.…”

“…На скорость набора пациентов в груп-пы исследования влияет и тщательность отбора, обилие критериев исключения. Так, ряд исследований не включал в курс пассивных тренировок пациентов с кардио-стимуляторами [25][26][27]31], хотя безопасность ЭСМ у этой категории пациентов была продемонстрирована ранее [38]. В исследование M. Kho и соавт.…”

Eficácia da eletroestimulação muscular expiratória na tosse de pacientes após acidente vascular encefálico

“…Sabe-se que o treino de força no músculo reto abdominal através de dispositivos de expiração forçada, melhora o recrutamento de fibras, e consequentemente a tosse, mas existe uma série de condições clínicas e limitações que contraindica o uso destes para essa finalidade [16][17][18][19] . Além disso, já existem evidências que a eletroestimulação transcutânea em musculatura respiratória tem bons efeitos em pacientes crônicos, inclusive neurológicos, em quadros de atrofia muscular [20][21][22][23][24][25] . A aplicação da corrente Russa é feita com eletrodos de superfície na musculatura esquelética para fornecimento de corrente elétrica gerada por um estimulador que despolariza o neurônio motor e induz contrações musculares involuntárias, e já existem evidências científicas sobre sua aplicabilidade clínica [26][27][28] .…”