The effect of passive mobilization associated with blood flow restriction and combined with electrical stimulation on cardiorespiratory safety, neuromuscular adaptations, physical function, and quality of life in comatose patients in an ICU: a randomized controlled clinical trial

Abstract

Background Intensive care unit-acquired atrophy and weakness are associated with high mortality, a reduction in physical function, and quality of life. Passive mobilization (PM) and neuromuscular electrical stimulation were applied in comatose patients; however, evidence is inconclusive regarding atrophy and weakness prevention. Blood flow restriction (BFR) associated with PM (BFRp) or with electrical stimulation (BFRpE) was able to reduce atrophy and increase muscle mass in spinal cord-injured patients, respectively. Bulky venous return occurs after releasing BFR, which can cause unknown repercussions on the cardiovascular system. Hence, the aim of this study was to investigate the effect of BFRp and BFRpE on cardiovascular safety and applicability, neuromuscular adaptations, physical function, and quality of life in comatose patients in intensive care units (ICUs). Methods Thirty-nine patients will be assessed at baseline (T0–18 h of coma) and randomly assigned to the PM (control group), BFRp, or BFRpE groups. The training protocol will be applied in both legs alternately, twice a day with a 4-h interval until coma awake, death, or ICU discharge. Cardiovascular safety and applicability will be evaluated at the first training session (T1). At T0 and 12 h after the last session (T2), muscle thickness and quality will be assessed. Global muscle strength and physical function will be assessed 12 h after T2 and ICU and hospital discharge for those who wake up from coma. Six and 12 months after hospital discharge, physical function and quality of life will be re-assessed. Discussion In view of applicability, the data will be used to inform the design and sample size of a prospective trial to clarify the effect of BFRpE on preventing muscle atrophy and weakness and to exert the greatest beneficial effects on physical function and quality of life compared to BFRp in comatose patients in the ICU. Trial registration Universal Trial Number (UTN) Registry UTN U1111-1241-4344. Retrospectively registered on 2 October 2019. Brazilian Clinical Trials Registry (ReBec) RBR-2qpyxf. Retrospectively registered on 21 January 2020, http://ensaiosclinicos.gov.br/rg/RBR-2qpyxf/

Blood Flow Restriction Training for Tendinopathy Rehabilitation: A Potential Alternative to Traditional Heavy-Load Resistance Training

“…Tendon morphological and mechanical properties were assessed by ultrasound, with the Achilles tendon adaptations comparable between both intervention groups. Both groups had significant increases in tendon stiffness and cross-sectional area (CSA), with gastrocnemius strength gains and muscle hypertrophy also comparably increased in both groups [211]. Similar findings were seen in a RCT comparing LL-BFRT (20-35% of 1-RM) with HL-RT (70-85% OF 1-RM) in healthy patellar tendons [212].…”

“…Several studies have investigated the effects of LL-BFRT on healthy tendons, including tendon morphological and mechanical properties (Table 1). A three-arm RCT with 55 participants, compared the effects of LL-BFRT (20-35% of 1-RM) with HL-RT (70-85% OF 1-RM) and a non-exercise control group on healthy Achilles tendon properties [211]. Participants performed standing and seated resisted calf raises, three times per week for 14 weeks, at 50% occlusion pressure applied to the proximal thigh.…”

Eletroestimulação neuromuscular como tratamento para perda muscular em pacientes de Terapia Intensiva: revisão sistemática

“…Entre os artigos incluídos nesta RS, sete deles (Bao et al, 2022;Cebeci et al, 2022;de Campos Biazon et al, 2021;Dirks et al, 2015;Hirose et al, 2013;Nakanishi et al, 2020;Wollersheim et al, 2019), relataram prevenção da atrofia muscular com a EENM.…”

“…Apesar de todos concordarem que o início precoce do tratamento com EENM promove melhores resultados, obtivemos dificuldade em encontrar um protocolo ideal para o começo e fim do tratamento. Nos estudos, alguns autores relatam que iniciaram o tratamento nas primeiras 24 a 48 horas após admissão do paciente e com duração até o encerramento da permanência na UTI, sendo por óbito ou alta (Bao et al, 2022;Campos et al, 2022;Campos Biazon et al, 2021).…”