As the population ages and critical care advances, there will be a growing number of survivors of critical illness who are at risk of intensive care unit (ICU)-acquired weakness. Bed rest is common in the ICU, causing adverse effects including muscle weakness. Consequently, patients need ICU-based interventions focused on the muscular system. While emerging evidence supports the benefits of early rehabilitation during mechanical ventilation, additional therapies may be beneficial. Neuromuscular electrical stimulation (NMES) is a promising modality for patients in the ICU, which can provide some muscular activity even very early during critical illness.
To discuss the implications of bed rest for patients with critical illness, summarize recent studies of early rehabilitation and NMES in the ICU, and describe a protocol for a pilot study of NMES in patients receiving mechanical ventilation.
Randomized, sham-controlled, concealed pilot study, with caregivers and outcome assessors blinded to treatment allocation.
Medical ICU
Mechanically ventilated for ≥1 day with an expected additional ≥2 days of ICU stay and meeting no exclusion criteria
NMES vs. sham control, applied to quadriceps, tibialis anterior, and gastrocnemius for 60 minutes per day
lower extremity muscle strength at hospital discharge (primary outcome)
Muscle strength is a surrogate measure, not a patient-centered outcome. Our assessments do not include laboratory, genetic, or histological measures aimed at a mechanistic understanding of NMES. The optimal duration/dose of NMES is unclear.
If NMES is beneficial, our study would help advance research aimed at reducing the burden of muscular weakness and physical disability faced by survivors of critical illness.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20110437v1?rss=1
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