Combining exercise, protein supplementation and electric stimulation to mitigate muscle wasting and improve outcomes for survivors of critical illness—The ExPrES study

Verceles, Avelino C.; Serra, Monica C.; Davis, Derik L.; Alon, Gad; Wells, Chris; Parker, Elizabeth; Sorkin, John D.; Bhatti, Waqas; Terrin, Michael L.

doi:10.1016/j.hrtlng.2022.11.013

Cited by 12 publications

(5 citation statements)

References 57 publications

(49 reference statements)

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“…Fourth, included RCTs assessed muscle mass change and adverse outcomes at different time points, and ICU-AW and muscle strength around ICU discharge. Fifth, we did not account for nutritional intervention because of the limited information available, although a combination of nutritional intervention is reportedly effective for reducing muscle atrophy and decreasing the length of hospital stay (50, 51). Finally, it was not feasible to contact most of the authors; therefore, the subgroup analysis was conducted only using the information available in the published article, which may include misclassification.…”

Section: Discussionmentioning

confidence: 99%

Effect of Neuromuscular Electrical Stimulation in Patients With Critical Illness: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nakanishi

Yoshihiro

Kawamura³

et al. 2023

Critical Care Medicine

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OBJECTIVES: Neuromuscular electrical stimulation (NMES) is used in the rehabilitation of patients with critical illness. However, it is unclear whether NMES prevents ICU-acquired weakness (ICU-AW). For this purpose, we conducted an updated systematic review and meta-analysis. DATA SOURCES: We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi databases from April 2019 to November 2022 to identify new randomized controlled trials to the previous meta-analysis. STUDY SELECTION: We systematically searched the literature for all randomized controlled trials on the effect of NMES in patients with critical illness. DATA EXTRACTION: Two authors independently selected the studies and extracted data. They calculated the pooled effect estimates associated with the occurrence of ICU-AW and adverse events as primary outcomes and muscle mass change, muscle strength, length of ICU stay, mortality, and quality of life as secondary outcomes. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS: Overall, eight studies were added to the previous 10 studies. Evidence suggests that the use of NMES reduces the occurrence of ICU-AW (six trials; risk ratio [RR], 0.48; 95% CI, 0.32–0.72); however, NMES may have little to no effect on pricking sensation in patients (eight trials; RR, 6.87; 95% CI, 0.84–56.50). NMES is likely to reduce the change in muscle mass (four trials; mean difference, –10.01; 95% CI, –15.54 to –4.48) and may increase muscle strength (six trials; standardized mean difference, 0.43; 95% CI, 0.19–0.68). Further, NMES may result in little to no difference in the length of ICU stay, and the evidence is uncertain about the effect on mortality and quality of life. CONCLUSIONS: This updated meta-analysis revealed that the use of NMES may result in a lower occurrence of ICU-AW in patients with critical illness, but its use may have little to no effect on pricking sensation in patients.

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Section: Discussionmentioning

confidence: 99%

Effect of Neuromuscular Electrical Stimulation in Patients With Critical Illness: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nakanishi

Yoshihiro

Kawamura³

et al. 2023

Critical Care Medicine

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“…In addition, Watanabe and colleagues demonstrated the effectiveness of a long-term protocol involving daily 20 min cycle ergometer training in addition to conventional treatment [ 14 ]. A recent study (the ExPrES study) evaluated that the combination of neuromuscular electrical stimulation, high-protein supplementation, mobility and rehabilitation attenuates lower limb muscle loss in ICU patients [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Technological Rehabilitation in Patients with Intensive Care Unit Weakness: A Randomized Controlled Pilot Study

Castelli

Iacovelli

Fusco

et al. 2023

JCM

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Intensive-Care-Unit-Acquired Weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients and can have a significant impact on long-term disability. Early rehabilitation has been suggested to facilitate the natural recovery process. This is a pilot, randomized, single-blind study that aimed to evaluate the effectiveness of intensive combined technological rehabilitation treatment including focal muscle vibration and non-immersive virtual reality for patients with severe acquired brain injury (sABI) and ICU-AW. Twenty-four patients were randomized into the conventional group, which performed only conventional rehabilitation, and the experimental group, which also performed technological treatment. At baseline and after 3 weeks of treatment, assessments of motor function, autonomy, disability and quality of life were conducted. At the end of the intervention, both groups showed significant improvements. However, patients in the experimental group achieved greater improvements in disability (p = 0.001) and quality of life (p = 0.001). The results show that intensive structured rehabilitation is effective in improving the motor function, disability and quality of life of patients with severe acquired brain injury and acquired weakness. The combination of non-immersive virtual reality training and focal muscle vibration can result in a significant improvement in overall disability and quality of life compared with conventional treatment alone.

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“…Regarding protein supplementation, in the early phase, the hypercatabolic state renders the muscle unable to benefit from amino acids [ 81 ]. However, recent studies suggest that protein supplementation used in conjunction with mobilization and at a later ICU stage may be beneficial [ 82 , 83 ].…”

Section: Managementmentioning

confidence: 99%

Critical illness-associated limb and diaphragmatic weakness

Le Stang,

Latronico,

Dres

et al. 2024

Current Opinion in Critical Care

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Purpose of review In the current review, we aim to highlight the evolving evidence on the diagnosis, prevention and treatment of critical illness weakness (CIW) and critical illness associated diaphragmatic weakness (CIDW). Recent findings In the ICU, several risk factors can lead to CIW and CIDW. Recent evidence suggests that they have different pathophysiological mechanisms and impact on outcomes, although they share common risk factors and may overlap in several patients. Their diagnosis is challenging, because CIW diagnosis is primarily clinical and, therefore, difficult to obtain in the ICU population, and CIDW diagnosis is complex and not easily performed at the bedside. All of these issues lead to underdiagnosis of CIW and CIDW, which significantly increases the risk of complications and the impact on both short and long term outcomes. Moreover, recent studies have explored promising diagnostic techniques that are may be easily implemented in daily clinical practice. In addition, this review summarizes the latest research aimed at improving how to prevent and treat CIW and CIDW. Summary This review aims to clarify some uncertain aspects and provide helpful information on developing monitoring techniques and therapeutic interventions for managing CIW and CIDW.

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Combining exercise, protein supplementation and electric stimulation to mitigate muscle wasting and improve outcomes for survivors of critical illness—The ExPrES study

Cited by 12 publications

References 57 publications

Effect of Neuromuscular Electrical Stimulation in Patients With Critical Illness: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Effect of Neuromuscular Electrical Stimulation in Patients With Critical Illness: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

The Role of Technological Rehabilitation in Patients with Intensive Care Unit Weakness: A Randomized Controlled Pilot Study

Critical illness-associated limb and diaphragmatic weakness

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