Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study

Vasiliki Gerovasili,Eleftherios Karatzanos,Christina Routsi,Panagiotis Politis,Serafim Nanas,Aikaterini Chatzimichail,Konstantinos Stefanidis,Apostolos Koroneos,Charis Roussos,Konstantinos Vitzilaios

doi:10.1186/cc8123

Abstract

IntroductionCritically ill patients are characterized by increased loss of muscle mass, partially attributed to sepsis and multiple organ failure, as well as immobilization. Recent studies have shown that electrical muscle stimulation (EMS) may be an alternative to active exercise in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients with myopathy. The aim of our study was to investigate the EMS effects on muscle mass preservation of critically ill patients with the use of ultrasonography (US).MethodsForty-nine critically ill patients (age: 59 ± 21 years) with an APACHE II admission score ≥13 were randomly assigned after stratification upon admission to receive daily EMS sessions of both lower extremities (EMS-group) or to the control group (control group). Muscle mass was evaluated with US, by measuring the cross sectional diameter (CSD) of the vastus intermedius and the rectus femoris of the quadriceps muscle.ResultsTwenty-six patients were finally evaluated. Right rectus femoris and right vastus intermedius CSD decreased in both groups (EMS group: from 1.42 ± 0.48 to 1.31 ± 0.45 cm, P = 0.001 control group: from 1.59 ± 0.53 to 1.37 ± 0.5 cm, P = 0.002; EMS group: from 0.91 ± 0.39 to 0.81 ± 0.38 cm, P = 0.001 control group: from 1.40 ± 0.64 to 1.11 ± 0.56 cm, P = 0.004, respectively). However, the CSD of the right rectus femoris decreased significantly less in the EMS group (-0.11 ± 0.06 cm, -8 ± 3.9%) as compared to the control group (-0.21 ± 0.10 cm, -13.9 ± 6.4%; P < 0.05) and the CSD of the right vastus intermedius decreased significantly less in the EMS group (-0.10 ± 0.05 cm, -12.5 ± 7.4%) as compared to the control group (-0.29 ± 0.28 cm, -21.5 ± 15.3%; P < 0.05).ConclusionsEMS is well tolerated and seems to preserve the muscle mass of critically ill patients. The potential use of EMS as a preventive and rehabilitation tool in ICU patients with polyneuromyopathy needs to be further investigated.Trial Registrationclinicaltrials.gov: NCT00882830

Highlights

Ill patients are characterized by increased loss of muscle mass, partially attributed to sepsis and multiple organ failure, as well as immobilization
Critical illness polyneuromyopathy (CIPNM) is a common complication of critical illness presenting with muscle weakness, diminished tendon reflexes, difficult weaning from mechanical ventilation [1,2], and prolonged intensive care unit (ICU) and hospital stay [2,3], and is associated with increased mortality [4]
Rectus femoris and vastus intermedius cross sectional diameter (CSD) could be assessed in 26 patients, 13 in the electrical muscle stimulation (EMS) group and 13 in the control group (Figure 1)

Summary

Introduction

Ill patients are characterized by increased loss of muscle mass, partially attributed to sepsis and multiple organ failure, as well as immobilization. Recent studies have shown that electrical muscle stimulation (EMS) may be an alternative to active exercise in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients with myopathy. The aim of our study was to investigate the EMS effects on muscle mass preservation of critically ill patients with the use of ultrasonography (US). Intensive insulin therapy has been proposed as a preventive therapy for CIPNM [9]. Results from recent studies have raised concerns regarding the safety and the mortality benefit of intensive insulin therapy [10,11]. No preventive or therapeutic tool has been proposed so far for CIPNM

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