title: Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock.
abstract: OBJECTIVE
  Intensive care unit admission is associated with muscle wasting and impaired physical function. We investigated the effect of early transcutaneous electrical muscle stimulation on quadriceps muscle volume in patients with septic shock.
  
  
  METHODS
  Randomized interventional study using a single-legged exercise design with the contralateral leg serving as a paired control.
  
  
  METHODS
  A mixed 18-bed intensive care unit at a tertiary care university hospital.
  
  
  METHODS
  Eight adult male intensive care unit patients with septic shock included within 72 hrs of diagnosis.
  
  
  METHODS
  After randomization of the quadriceps muscles, transcutaneous electrical muscle stimulation was applied on the intervention side for 7 consecutive days and for 60 mins per day. All patients underwent computed tomographic scans of both thighs immediately before and after the 7-day treatment period. The quadriceps muscle was manually delineated on the computed tomography slices, and muscle volumes were calculated after three-dimensional reconstruction.
  
  
  RESULTS
  Median age and Acute Physiology and Chronic Health Evaluation II score were 67 years (interquartile range, 64-72 years) and 25 (interquartile range, 20-29), respectively. During the 7-day study period, the volume of the quadriceps muscle on the control thigh decreased by 16% (4-21%, p=.03) corresponding to a rate of 2.3% per day. The volume of the stimulated muscle decreased by 20% (3-25%, p=.04) corresponding to a rate of 2.9% per day (p=.12 for the difference in decrease). There was no difference in muscle volume between the stimulated and nonstimulated thigh at baseline (p=.10) or at day 7 (p=.12). The charge delivered to the muscle tissue per training session (0.82 [0.66-1.18] coulomb) correlated with the maximum sequential organ failure assessment score.
  
  
  CONCLUSIONS
  We observed a marked decrease in quadriceps volume within the first week of intensive care for septic shock. This loss of muscle mass was unaffected by transcutaneous electrical muscle stimulation applied for 60 mins per day for 7 days.
authors.affiliation: Department of Intensive Care, the Section for Surgical Pathophysiology, Rigshospitalet, University Hospital of Copenhagen, and the Laboratory of Biological Anthropology, Institute of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark. jpoulsen@dadlnet.dk
authors.forename: Jesper B
authors.initials: JB
authors.lastname: Poulsen
authors.forename: Kirsten
authors.initials: K
authors.lastname: Møller
authors.forename: Claus V
authors.initials: CV
authors.lastname: Jensen
authors.forename: Sigge
authors.initials: S
authors.lastname: Weisdorf
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: Anders
authors.initials: A
authors.lastname: Perner
mesh_terms: D000368:Aged; D005081:Exercise Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D052097:Quadriceps Muscle / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome