Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle

Abstract

Background Although the combination of rehabilitation and nutrition may be important for the prevention of intensive care unit (ICU)-acquired weakness, a protocolized intervention of this combination has not yet been reported. We herein developed an original combined protocol and evaluated its efficacy. Methods In this single-center historical control study, we enrolled adult patients admitted to the ICU. Patients in the control group received standard care, while those in the intervention group received the protocol-based intervention. The ICU mobility scale was used to set goals for early mobilization and a neuromuscular electrical stimulation was employed when patients were unable to stand. The nutritional status was assessed for nutritional therapy, and target calorie delivery was set at 20 or 30 kcal/kg/day and target protein delivery at 1.8 g/kg/day in the intervention group. The primary endpoint was a decrease in femoral muscle volume in 10 days assessed by computed tomography. Results Forty-five patients in the control group and 56 in the intervention group were included in the analysis. Femoral muscle volume loss was significantly lower in the intervention group (11.6 vs 14.5%, p = 0.03). The absolute risk difference was 2.9% (95% CI 0.1–5.6%). Early mobilization to a sitting position by day 10 was achieved earlier (p = 0.03), and mean calorie delivery (20.1 vs. 16.8 kcal/kg/day, p = 0.01) and mean protein delivery (1.4 vs. 0.8 g/kg/day, p < 0.01) were higher in the intervention group. Conclusion The protocolized intervention, combining early mobilization and high-protein nutrition, contributed to the achievement of treatment goals and prevention of femoral muscle volume loss. Trial registration number The present study is registered at the University Hospital Medical Information Network-clinical trials registry (UMIN000040290, Registration date: May 7, 2020).

Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial

“…The fact that there was no increase in muscle mass in the NMES group can be explained by some factors intrinsic to the dose–effect [ 34 ]. The treatment time required for NMES to produce muscle hypertrophy in critically ill patients could be longer than 7 days [ 34 – 36 ]. Furthermore, the effect on strength gain and trophism is directly proportional to the strength of the evoked contraction [ 37 ].…”

Physical therapy and nutrition therapy: synergistic, antagonistic, or independent interventions?

“…The main type of nutritional interventions included overall nutritional intake with delivery of both calories and proteins. Physical interventions were: early functional rehabilitation in two studies [19,23], electrical muscle stimulation with early goal-directed rehabilitation in two studies [20,22], and two trials tested…”

“…In 101 patients, Nakano et al [22] conducted a historical control trial combining early intensive goal-directed rehabilitation with electrical muscle stimulation and high-protein nutrition (target calorie delivery was set at 20 or 30 kcal/kg/day and target protein delivery at 1.8 g/kg/day in the intervention group), compared to usual care. Femoral muscle volume loss was significantly less in the intervention group (11.6 vs. 14.5%, P ¼ 0.03), however the intervention did not have significant impacts on overall survival or ICU or hospital length of stay.…”

Management and Prevention of Sarcopenia in Era Covid-19

“…Rehabilitation is usually a diverse job. As indicated by data from persons who had been treated in the Intensive Care Unit setting, combining its conventional forms with other procedures such as dietary intervention and instrumental techniques utilizing neuromuscular electrical stimulation [20] is a crucial part of post-COVID-19 patient rehabilitation.…”