Differential contractile response of critically ill patients to neuromuscular electrical stimulation
Abstract Background Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response...
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BMC
2019-09-01
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Online Access: | http://link.springer.com/article/10.1186/s13054-019-2540-4 |
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doaj-65b5f326fd8e42459ebdecf28c9657c5 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Julius J. Grunow Moritz Goll Niklas M. Carbon Max E. Liebl Steffen Weber-Carstens Tobias Wollersheim |
spellingShingle |
Julius J. Grunow Moritz Goll Niklas M. Carbon Max E. Liebl Steffen Weber-Carstens Tobias Wollersheim Differential contractile response of critically ill patients to neuromuscular electrical stimulation Critical Care Neuromuscular electrical stimulation Intensive care unit-acquired weakness Critical illness Critical illness myopathy Early mobilisation |
author_facet |
Julius J. Grunow Moritz Goll Niklas M. Carbon Max E. Liebl Steffen Weber-Carstens Tobias Wollersheim |
author_sort |
Julius J. Grunow |
title |
Differential contractile response of critically ill patients to neuromuscular electrical stimulation |
title_short |
Differential contractile response of critically ill patients to neuromuscular electrical stimulation |
title_full |
Differential contractile response of critically ill patients to neuromuscular electrical stimulation |
title_fullStr |
Differential contractile response of critically ill patients to neuromuscular electrical stimulation |
title_full_unstemmed |
Differential contractile response of critically ill patients to neuromuscular electrical stimulation |
title_sort |
differential contractile response of critically ill patients to neuromuscular electrical stimulation |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2019-09-01 |
description |
Abstract Background Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response, our aim was to characterise the response of critically ill patients to NMES and investigate potential outcome benefits of an adequate contractile response. Methods This is a sub-analysis of a randomised controlled trial investigating early muscle activating measures together with protocol-based physiotherapy in patients with a SOFA score ≥ 9 within the first 72 h after admission. Included patients received protocol-based physiotherapy twice daily for 20 min and NMES once daily for 20 min, bilaterally on eight muscle groups. Electrical current was increased up to 70 mA or until a contraction was detected visually or on palpation. Muscle strength was measured by a blinded assessor at the first adequate awakening and ICU discharge. Results One thousand eight hundred twenty-four neuromuscular electrical stimulations in 21 patients starting on day 3.0 (2.0/6.0) after ICU admission were included in this sub-analysis. Contractile response decreased from 64.4% on day 1 to 25.0% on day 7 with a significantly lower response rate in the lower extremities and proximal muscle groups. The electrical current required to elicit a contraction did not change over time (day 1, 50.2 [31.3/58.8] mA; day 7, 45.3 [38.0/57.5] mA). The electrical current necessary for a contractile response was higher in the lower extremities. At the first awakening, patients presented with significant weakness (3.2 [2.5/3.8] MRC score). When dividing the cohort into responders and non-responders (> 50% vs. ≤ 50% contractile response), we observed a significantly higher SOFA score in non-responders. The electrical current necessary for a muscle contraction in responders was significantly lower (38.0 [32.8/42.9] vs. 54.7 [51.3/56.0] mA, p < 0.001). Muscle strength showed higher values in the upper extremities of responders at ICU discharge (4.4 [4.1/4.6] vs. 3.3 [2.8/3.8] MRC score, p = 0.036). Conclusion Patients show a differential contractile response to NMES, which appears to be dependent on the severity of illness and also relevant for potential outcome benefits. Trial registration ISRCTN ISRCTN19392591, registered 17 February 2011 |
topic |
Neuromuscular electrical stimulation Intensive care unit-acquired weakness Critical illness Critical illness myopathy Early mobilisation |
url |
http://link.springer.com/article/10.1186/s13054-019-2540-4 |
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AT juliusjgrunow differentialcontractileresponseofcriticallyillpatientstoneuromuscularelectricalstimulation AT moritzgoll differentialcontractileresponseofcriticallyillpatientstoneuromuscularelectricalstimulation AT niklasmcarbon differentialcontractileresponseofcriticallyillpatientstoneuromuscularelectricalstimulation AT maxeliebl differentialcontractileresponseofcriticallyillpatientstoneuromuscularelectricalstimulation AT steffenwebercarstens differentialcontractileresponseofcriticallyillpatientstoneuromuscularelectricalstimulation AT tobiaswollersheim differentialcontractileresponseofcriticallyillpatientstoneuromuscularelectricalstimulation |
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spelling |
doaj-65b5f326fd8e42459ebdecf28c9657c52020-11-25T03:12:44ZengBMCCritical Care1364-85352019-09-0123111210.1186/s13054-019-2540-4Differential contractile response of critically ill patients to neuromuscular electrical stimulationJulius J. Grunow0Moritz Goll1Niklas M. Carbon2Max E. Liebl3Steffen Weber-Carstens4Tobias Wollersheim5Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of HealthDepartment of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of HealthDepartment of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of HealthDepartment of Physical Medicine and Rehabilitation, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of HealthDepartment of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of HealthDepartment of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of HealthAbstract Background Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response, our aim was to characterise the response of critically ill patients to NMES and investigate potential outcome benefits of an adequate contractile response. Methods This is a sub-analysis of a randomised controlled trial investigating early muscle activating measures together with protocol-based physiotherapy in patients with a SOFA score ≥ 9 within the first 72 h after admission. Included patients received protocol-based physiotherapy twice daily for 20 min and NMES once daily for 20 min, bilaterally on eight muscle groups. Electrical current was increased up to 70 mA or until a contraction was detected visually or on palpation. Muscle strength was measured by a blinded assessor at the first adequate awakening and ICU discharge. Results One thousand eight hundred twenty-four neuromuscular electrical stimulations in 21 patients starting on day 3.0 (2.0/6.0) after ICU admission were included in this sub-analysis. Contractile response decreased from 64.4% on day 1 to 25.0% on day 7 with a significantly lower response rate in the lower extremities and proximal muscle groups. The electrical current required to elicit a contraction did not change over time (day 1, 50.2 [31.3/58.8] mA; day 7, 45.3 [38.0/57.5] mA). The electrical current necessary for a contractile response was higher in the lower extremities. At the first awakening, patients presented with significant weakness (3.2 [2.5/3.8] MRC score). When dividing the cohort into responders and non-responders (> 50% vs. ≤ 50% contractile response), we observed a significantly higher SOFA score in non-responders. The electrical current necessary for a muscle contraction in responders was significantly lower (38.0 [32.8/42.9] vs. 54.7 [51.3/56.0] mA, p < 0.001). Muscle strength showed higher values in the upper extremities of responders at ICU discharge (4.4 [4.1/4.6] vs. 3.3 [2.8/3.8] MRC score, p = 0.036). Conclusion Patients show a differential contractile response to NMES, which appears to be dependent on the severity of illness and also relevant for potential outcome benefits. Trial registration ISRCTN ISRCTN19392591, registered 17 February 2011http://link.springer.com/article/10.1186/s13054-019-2540-4Neuromuscular electrical stimulationIntensive care unit-acquired weaknessCritical illnessCritical illness myopathyEarly mobilisation |