Neuromuscular electrical stimulation in mechanically ventilated patients: A randomized, sham-controlled pilot trial with blinded outcome assessment

Abstract

Purpose To compare neuromuscular electrical stimulation (NMES) versus sham on leg strength at hospital discharge in mechanically ventilated patients. Materials and Methods We conducted a randomized pilot study of NMES versus sham applied to 3 bilateral lower extremity muscle groups for 60 minutes daily in ICU. Between 6/2008 and 3/2013, we enrolled adults who were receiving mechanical ventilation within the first week of ICU stay, and who could transfer independently from bed to chair before hospital admission. The primary outcome was lower extremity muscle strength at hospital discharge using Medical Research Council score (maximum = 30). Secondary outcomes at hospital discharge included walking distance and change in lower extremity strength from ICU awakening. Clinicaltrials.gov:NCT00709124. Results We stopped enrollment early after 36 patients due to slow patient accrual and the end of research funding. For NMES versus sham, mean (SD) lower extremity strength was 28(2) versus 27(3), p=0.072. Among secondary outcomes, NMES versus sham patients had a greater mean (SD) walking distance (514(389) vs. 251(210) feet, p=0.050) and increase in muscle strength (5.7(5.1) vs. 1.8(2.7), p=0.019). Conclusions In this pilot randomized trial, NMES did not significantly improve leg strength at hospital discharge. Significant improvements in secondary outcomes require investigation in future research.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

“…According to the results of an intent‐to‐treat analysis436 of the findings obtained by Routesi et al 434. and Kho et al .,435 there were no significant differences in the incidence of ICU‐AW in comparison with the control group. This body of evidence can be said to be inadequate, in consideration of the low number of subjects in the electric muscle stimulation group and the associated risk of bias, in addition to the lack of a high‐quality systematic review or meta‐analysis at this time.…”

“…Two single‐center RCTs have reported on the efficacy of electrical muscle stimulation as a measure to prevent ICU‐AW 434, 435. According to the results of an intent‐to‐treat analysis436 of the findings obtained by Routesi et al 434.…”

Parallels between astronauts and terrestrial patients – Taking physiotherapy rehabilitation “To infinity and beyond”

“…In chronically ventilated patients mobility therapy with NEMS results in significantly improved muscle strength compared to those who receive standard mobility therapy alone (Zanotti et al, 2003), although these effects have not yet been reproduced in the critically ill (Kho et al, 2015). A potential alternative to NEMS is functional electrical stimulation (FES) which differs from NEMS in that it stimulates muscles in functional patterns.…”

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

“…[31] было спланирова-но как двойное слепое, плацебо-контролируемое, в него включили пациентов многопрофильного ОРИТ, которым проводили стимуляцию четырехглавой мышцы бедра и мышц голени (средняя продолжительность курса ЭСМ -9 дней). При сравнении групп ЭСМ и контроля выявлены различия на этапах пребывания пациента в стационаре.…”

“…Можно отметить, что ранее только единичные работы были посвящены использованию ЭСМ в ОРИТ. В по-следние годы возросло число таких исследований [29][30][31] и стали появляться попытки систематизировать нако-пленный опыт [35][36][37].…”