title: Muscle weakness in septic patients requiring mechanical ventilation: protective effect of transcutaneous neuromuscular electrical stimulation.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of transcutaneous neuromuscular electrical stimulation (NMES) on muscle strength in septic patients requiring mechanical ventilation (MV).
  
  
  METHODS
  Sixteen septic patients requiring MV and having 1 or more organ failure other than respiratory dysfunction were enrolled within 48 hours from admission to the intensive care unit. Neuromuscular electrical stimulation was administered twice a day on brachial biceps and vastus medialis (quadriceps) of 1 side of the body until MV withdrawal. Blinded investigators measured arm and thigh circumferences, biceps thickness by ultrasonography, and muscle strength after awakening with Medical Research Council scale.
  
  
  RESULTS
  Two patients died before strength evaluation and were excluded from the analysis. Neuromuscular electrical stimulation was applied for 13 days (interquartile range, 7-30 days). Biceps (P = .005) and quadriceps (P = .034) strengths were significantly higher on the stimulated side at the last day of NMES. Improvement was mainly observed in more severe and weaker patients. Circumference of the nonstimulated arm decreased at the last day of NMES (P = .015), whereas no other significant differences in limb circumferences or biceps thickness were observed.
  
  
  CONCLUSIONS
  Neuromuscular electrical stimulation was associated with an increase in strength of the stimulated muscle in septic patients requiring MV. Neuromuscular electrical stimulation may be useful to prevent muscle weakness in this population.
authors.affiliation: Intensive Care Unit, CEMIC (Centro de Educación Médica e Investigaciones Clínicas), C1425ASS Buenos Aires, Argentina. prodriguez@cemic.edu.ar
authors.forename: Pablo O
authors.initials: PO
authors.lastname: Rodriguez
authors.forename: Mariano
authors.initials: M
authors.lastname: Setten
authors.forename: Luis P
authors.initials: LP
authors.lastname: Maskin
authors.forename: Ignacio
authors.initials: I
authors.lastname: Bonelli
authors.forename: Silvana Romero
authors.initials: SR
authors.lastname: Vidomlansky
authors.forename: Shiry
authors.initials: S
authors.lastname: Attie
authors.forename: Silvana L
authors.initials: SL
authors.lastname: Frosiani
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kozima
authors.forename: Ricardo
authors.initials: R
authors.lastname: Valentini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications / Q000534:rehabilitation*; D053580:Muscle Strength; D018908:Muscle Weakness / Q000209:etiology / Q000517:prevention & control*; D011115:Polyneuropathies / Q000209:etiology / Q000517:prevention & control*; D052097:Quadriceps Muscle; D012121:Respiration, Artificial; D018805:Sepsis / Q000150:complications / Q000534:rehabilitation*; D016037:Single-Blind Method; D013848:Thigh; D004561:Transcutaneous Electric Nerve Stimulation