Neuromuscular electrical stimulation in critically ill traumatic brain injury patients attenuates muscle atrophy, neurophysiological disorders, and weakness: a randomized controlled trial

Abstract

BackgroundCritically ill traumatic brain injury (TBI) patients experience extensive muscle damage during their stay in the intensive care unit. Neuromuscular electrical stimulation (NMES) has been considered a promising treatment to reduce the functional and clinical impacts of this. However, the time needed for NMES to produce effects over the muscles is still unclear. This study primarily aimed to assess the time needed and effects of an NMES protocol on muscle architecture, neuromuscular electrophysiological disorder (NED), and muscle strength, and secondarily, to evaluate the effects on plasma systemic inflammation, catabolic responses, and clinical outcomes.MethodsWe performed a randomized clinical trial in critically ill TBI patients. The control group received only conventional physiotherapy, while the NMES group additionally underwent daily NMES for 14 days in the lower limb muscles. Participants were assessed at baseline and on days 3, 7, and 14 of their stay in the intensive care unit. The primary outcomes were assessed with muscle ultrasound, neuromuscular electrophysiology, and evoked peak force, and the secondary outcomes with plasma cytokines, matrix metalloproteinases, and clinical outcomes.ResultsSixty participants were randomized, and twenty completed the trial from each group. After 14 days, the control group presented a significant reduction in muscle thickness of tibialis anterior and rectus femoris, mean of − 0.33 mm (− 14%) and − 0.49 mm (− 21%), p < 0.0001, respectively, while muscle thickness was preserved in the NMES group. The control group presented a higher incidence of NED: 47% vs. 0% in the NMES group, p < 0.0001, risk ratio of 16, and the NMES group demonstrated an increase in the evoked peak force (2.34 kg/f, p < 0.0001), in contrast to the control group (− 1.55 kg/f, p < 0.0001). The time needed for the NMES protocol to prevent muscle architecture disorders and treat weakness was at least 7 days, and 14 days to treat NED. The secondary outcomes exhibited less precise results, with confidence intervals that spanned worthwhile or trivial effects.ConclusionsNMES applied daily for fourteen consecutive days reduced muscle atrophy, the incidence of NED, and muscle weakness in critically ill TBI patients. At least 7 days of NMES were required to elicit the first significant results.Trial registrationThe trial was registered at ensaiosclinicos.gov.br under protocol RBR-8kdrbz on 17 January 2016.

Electrical muscle stimulation intervention in the acute phase of neuromyelitis optica: Two case reports

“… 8 , 9 In this study, the subjects showed minimal change in the thickness of the VL muscle. The results of this report support previous findings 8 , 11 , 13 and suggest that the use of EMS to treat muscles with paralysis seems safe and feasible in the early phase of NMO.…”

Breath-synchronized electrical stimulation of the expiratory muscles in mechanically ventilated patients: a randomized controlled feasibility study and pooled analysis

“…We did not find associations with systemic inflammatory response, but with the large variability in pro-inflammatory state of ICU patients, no clear implications can be generated about potential protective effects. This is in line with recent work [ 30 ] on limb muscle FES in ICU patients and with data in healthy subjects demonstrating that the effects of FES are similar to those of mild exercise [ 31 ], i.e., inhibiting pro-inflammatory cytokines [ 32 ]. Furthermore, Hickmann et al [ 33 ] showed that early exercise during the onset of septic shock did not enhance inflammation and preserved muscle mass.…”

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

“…So far, different ergometers have been developed allowing to record evoked force in response to ES and/or MS in ICU patients on three muscle groups (Fig. 2 c–e): adductor pollicis [ 12 , 13 , 55 ], ankle dorsiflexors [ 15 , 56 ] and quadriceps [ 14 , 57 , 58 ].…”

“…To overcome these limitations, non-volitional techniques combining electrical [ 12 ] or magnetic [ 13 ] stimulation applied to a motor nerve or over a muscle belly [ 14 ] with force measurements on a dedicated bedside ergometer have emerged in the field of ICU. This allows to record evoked-force in fully sedated patients, so that measurement can be performed early after ICU admission ( i.e.…”