title: Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial.
abstract: BACKGROUND
  Critical illness polyneuromyopathy (CIPNM) is a common complication of critical illness presenting with muscle weakness and is associated with increased duration of mechanical ventilation and weaning period. No preventive tool and no specific treatment have been proposed so far for CIPNM. Electrical muscle stimulation (EMS) has been shown to be beneficial in patients with severe chronic heart failure and chronic obstructive pulmonary disease. Aim of our study was to assess the efficacy of EMS in preventing CIPNM in critically ill patients.
  
  
  METHODS
  One hundred and forty consecutive critically ill patients with an APACHE II score >or= 13 were randomly assigned after stratification to the EMS group (n = 68) (age:61 +/- 19 years) (APACHE II:18 +/- 4, SOFA:9 +/- 3) or to the control group (n = 72) (age:58 +/- 18 years) (APACHE II:18 +/- 5, SOFA:9 +/- 3). Patients of the EMS group received daily EMS sessions. CIPNM was diagnosed clinically with the medical research council (MRC) scale for muscle strength (maximum score 60, <48/60 cut off for diagnosis) by two unblinded independent investigators. Duration of weaning from mechanical ventilation and intensive care unit (ICU) stay were recorded.
  
  
  RESULTS
  Fifty two patients could be finally evaluated with MRC; 24 in the EMS group and 28 in the control group. CIPNM was diagnosed in 3 patients in the EMS group as compared to 11 patients in the control group (OR = 0.22; CI: 0.05 to 0.92, P = 0.04). The MRC score was significantly higher in patients of the EMS group as compared to the control group [58 (33 to 60) vs. 52 (2 to 60) respectively, median (range), P = 0.04). The weaning period was statistically significantly shorter in patients of the EMS group vs. the control group [1 (0 to 10) days vs. 3 (0 to 44) days, respectively, median (range), P = 0.003].
  
  
  CONCLUSIONS
  This study suggests that daily EMS sessions prevent the development of CIPNM in critically ill patients and also result in shorter duration of weaning. Further studies should evaluate which patients benefit more from EMS and explore the EMS characteristics most appropriate for preventing CIPNM.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00882830.
authors.affiliation: First Critical Care Department, National and Kapodistrian University of Athens Evangelismos Hospital, Ypsilantou 45-47, Athens, Greece. croutsi@hotmail.com
authors.forename: Christina
authors.initials: C
authors.lastname: Routsi
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Gerovasili
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vasileiadis
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Karatzanos
authors.forename: Theodore
authors.initials: T
authors.lastname: Pitsolis
authors.forename: Elli
authors.initials: E
authors.lastname: Tripodaki
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Markaki
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Zervakis
authors.forename: Serafim
authors.initials: S
authors.lastname: Nanas
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D016638:Critical Illness; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology*; D011115:Polyneuropathies / Q000517:prevention & control*; D012121:Respiration, Artificial