title: Feasibility of neuromuscular electrical stimulation in critically ill patients.
abstract: OBJECTIVE
  Critically ill patients often develop intensive care unit-acquired weakness. Reduction in muscle mass and muscle strength occurs early after admission to the intensive care unit (ICU). Although early active muscle training could attenuate this intensive care unit-acquired weakness, in the early phase of critical illness, a large proportion of patients are unable to participate in any active mobilization. Neuromuscular electrical stimulation (NMES) could be an alternative strategy for muscle training. The aim of this study was to investigate the safety and feasibility of NMES in critically ill patients.
  
  
  METHODS
  This is an observational study.
  
  
  METHODS
  The setting is in the medical and surgical ICUs of a tertiary referral university hospital.
  
  
  METHODS
  Fifty patients with a prognosticated prolonged stay of at least 6 days were included on day 3 to 5 of their ICU stay. Patients with preexisting neuromuscular disorders and patients with musculoskeletal conditions limiting quadriceps contraction were excluded.
  
  
  METHODS
  Twenty-five minutes of simultaneous bilateral NMES of the quadriceps femoris muscle. This intervention was performed 5 days per week (Monday-Friday). Effective muscle stimulation was defined as a palpable and visible contraction (partial or full muscle bulk).
  
  
  METHODS
  The following parameters, potentially affecting contraction upon NMES, were assessed: functional status before admission to the ICU (Barthel index), type and severity of illness (Acute Physiology And Chronic Health Evaluation II score and sepsis), treatments possibly influencing the muscle contraction (corticosteroids, vasopressors, inotropes, aminoglycosides, and neuromuscular blocking agents), level of consciousness (Glasgow Coma Scale, score on 5 standardized questions evaluating awakening, and sedation agitation scale), characteristics of stimulation (intensity of the NMES, number of sessions per patient, and edema), and neuromuscular electrophysiologic characteristics. Changes in heart rate, blood pressure, oxygen saturation, respiratory rate, and skin reactions were registered to assess the safety of the technique.
  
  
  RESULTS
  In 50% of the patients, an adequate quadriceps contraction was obtained in at least 75% of the NMES sessions. Univariate analysis showed that lower limb edema (P<.001), sepsis (P=.008), admission to the medical ICU (P=.041), and treatment with vasopressors (P=.011) were associated with impaired quadriceps contraction. A backward multivariate analysis identified presence of sepsis, lower limb edema, and use of vasopressors as independent predictors of impaired quadriceps contraction (R2=59.5%). Patients responded better to NMES in the beginning of their ICU stay in comparison with after 1 week of ICU stay. There was no change in any of the safety end points with NMES.
  
  
  CONCLUSIONS
  Critically ill patients having sepsis, edema, or receiving vasopressors were less likely to respond to NMES with an adequate quadriceps contraction. Neuromuscular electrical stimulation is a safe intervention to be administered in the ICU.
authors.affiliation: KU Leuven-University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Segers
authors.affiliation: Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Department of General Internal Medicine, UZ Leuven, Leuven, Belgium.
authors.forename: Greet
authors.initials: G
authors.lastname: Hermans
authors.affiliation: KU Leuven/UZ Leuven, Department of Physical Medicine and Rehabilitation, Leuven, Belgium.
authors.forename: Frans
authors.initials: F
authors.lastname: Bruyninckx
authors.affiliation: KU Leuven/UZ Leuven, Department of Intensive Care Medicine, Leuven, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Meyfroidt
authors.affiliation: KU Leuven-University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: Langer
authors.affiliation: KU Leuven-University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium. Electronic address: Rik.Gosselink@kuleuven.be.
authors.forename: Rik
authors.initials: R
authors.lastname: Gosselink
mesh_terms: D018806:APACHE; D000368:Aged; D000704:Analysis of Variance; D016638:Critical Illness; D004487:Edema / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects / Q000502:physiology*; D053580:Muscle Strength / Q000502:physiology; D018908:Muscle Weakness / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000187:drug effects / Q000502:physiology*; D012449:Safety; D018805:Sepsis / Q000503:physiopathology; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000494:pharmacology
chemical_list: D014662:Vasoconstrictor Agents
keywords: Critical illness; Early mobilization; Electrical stimulation; Intensive care; Intensive care unit–acquired weakness; Physical therapy