Hemodynamic effects of electrical muscle stimulation in the prophylaxis of deep vein thrombosis for intensive care unit patients: a randomized trial

Abstract

BackgroundDeep vein thrombosis (DVT) is a major complication in critical care. There are various methods of prophylaxis, but none of them fully prevent DVT, and each method has adverse effects. Electrical muscle stimulation (EMS) could be a new effective approach to prevent DVT in intensive care unit (ICU) patients. We hypothesized that EMS increases the venous flow of the lower limbs and has a prophylactic effect against the formation of DVT.MethodsThis study included 26 patients admitted to a single ICU. We enrolled patients who could not move themselves due to spinal cord injury, head injury, central nervous system abnormalities, and sedation for mechanical ventilation. The patients were randomly allocated to either the EMS group or the control group. Patients in the EMS group received 30-min sessions of EMS applied to the bilateral lower extremities on arbitrary days within 14 days after admission. The control patients received no EMS. The peak flow velocity and diameter of the popliteal vein (Pop.V) and common femoral vein (CFV) were measured by ultrasound and then the volumes of venous flow were calculated using a formula.ResultsThere were no statistically significant differences in patient characteristics between the two groups except for the mortality rate. In the EMS group, the median and interquartile range (IQR, 25th–75th percentile) of velocities of the Pop.V and CFV were higher during EMS compared with at rest: 10.6 (8.0–14.8) vs 24.5 (15.1–37.8) cm/s and 17.0 (12.3–23.8) vs 24.3 (17.0–33.0) cm/s, respectively (p < 0.05). The median (IQR) of volumes of venous flow of the Pop.V and CFV at rest and during EMS were 4.2 (2.7–7.2) vs 8.6 (5.4–16.1) cm3/s and 12.9 (9.7–21.4) vs 20.8 (12.3–34.1) cm3/s, respectively (p < 0.05). There were no major complications related to EMS.ConclusionsEMS increased the venous flow of the lower limbs. EMS could be one potential method for venous thromboprophylaxis.Trial registration UMIN000013642

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

“…We demonstrated that NMES can reduce the incidence of NED. The beneficial effects of NMES to treat NED may have been elicited through improvement in the neuromuscular and systemic circulation [39, 40]. The improvement in blood supply may protect neurons and myofibers against tissue dysoxia, which has been considered an important mechanism to induce axonal degeneration [39, 41].…”

Garments for functional electrical stimulation: Design and proofs of concept

“…2 NMES has been shown beneficial for knee ligament surgery, 3 prevention and management of venous diseases, 4 muscle weakness with advanced progressive disease (e.g. chronic respiratory disease, chronic heart failure, thoracic cancer), 5 critically ill patients confined to bed, 6,7 and neurorehabilitation after spinal cord injury (SCI) or stroke. 8 Functional electrical stimulation (FES) is the use of NMES to execute a functional movement (e.g.…”

Handgrip exercise by the non-affected hand increases venous return in the contralateral axillary vein in patients with stroke: a pilot study

“…There was no significant difference in the venous diameter between the baseline and resistance exercise conditions in this study, but the venous flow velocity significantly increased. In a previous study, Ojima et al [ 15 ] reported no differences in the popliteal vein or common femoral vein diameters between the at-rest condition and during electrical muscle stimulation, although peak venous flow velocities were higher during electrical muscle stimulation than at rest. Likewise, the increased venous flow volume resulted primarily from increases in the time-averaged mean flow velocity in this study using rhythmic handgrip exercise.…”