Abstract
IntroductionCritical illness polyneuromyopathy (CIPNM) is a common complication of critical illness presenting with muscle weakness and is associated with increased duration of mechanical ventilation and weaning period. No preventive tool and no specific treatment have been proposed so far for CIPNM. Electrical muscle stimulation (EMS) has been shown to be beneficial in patients with severe chronic heart failure and chronic obstructive pulmonary disease. Aim of our study was to assess the efficacy of EMS in preventing CIPNM in critically ill patients.MethodsOne hundred and forty consecutive critically ill patients with an APACHE II score ≥ 13 were randomly assigned after stratification to the EMS group (n = 68) (age:61 ± 19 years) (APACHE II:18 ± 4, SOFA:9 ± 3) or to the control group (n = 72) (age:58 ± 18 years) (APACHE II:18 ± 5, SOFA:9 ± 3). Patients of the EMS group received daily EMS sessions. CIPNM was diagnosed clinically with the medical research council (MRC) scale for muscle strength (maximum score 60, <48/60 cut off for diagnosis) by two unblinded independent investigators. Duration of weaning from mechanical ventilation and intensive care unit (ICU) stay were recorded.ResultsFifty two patients could be finally evaluated with MRC; 24 in the EMS group and 28 in the control group. CIPNM was diagnosed in 3 patients in the EMS group as compared to 11 patients in the control group (OR = 0.22; CI: 0.05 to 0.92, P = 0.04). The MRC score was significantly higher in patients of the EMS group as compared to the control group [58 (33 to 60) vs. 52 (2 to 60) respectively, median (range), P = 0.04). The weaning period was statistically significantly shorter in patients of the EMS group vs. the control group [1 (0 to 10) days vs. 3 (0 to 44) days, respectively, median (range), P = 0.003].ConclusionsThis study suggests that daily EMS sessions prevent the development of CIPNM in critically ill patients and also result in shorter duration of weaning. Further studies should evaluate which patients benefit more from EMS and explore the EMS characteristics most appropriate for preventing CIPNM.Trial Registration NumberClinicalTrials.gov NCT00882830
Highlights
Critical illness polyneuromyopathy (CIPNM) is a common complication of critical illness presenting with muscle weakness and is associated with increased duration of mechanical ventilation and weaning period
This study suggests that daily Electrical muscle stimulation (EMS) sessions prevent the development of CIPNM in critically ill patients and result in shorter duration of weaning
Looking for the potentially reversible risk factors and subsequent adjustment of therapy are so far advocated as preventive measures to decrease the risk of CIPNM
Summary
Critical illness polyneuromyopathy (CIPNM) is a common complication of critical illness presenting with muscle weakness and is associated with increased duration of mechanical ventilation and weaning period. Critical illness polyneuromyopathy (CIPNM) is an acquired neuromuscular disorder observed in survivors of acute critical illness It is characterized by profound muscle weakness and diminished or absent deep tendon reflexes [1] and is associated with delayed weaning from mechanical ventilation [2] suggesting a possible relation. Electrical muscle stimulation (EMS) has been used as an alternative to active exercise in patients with chronic heart failure (CHF) [11] and chronic obstructive pulmonary disease (COPD) [12,13] Many of these patients, even those who are clinically stable, experience severe dyspnea on exertion, which can prohibit the regular application of conventional exercise training, considered necessary for an integrated therapeutic approach. After performing a 45-minute session of EMS on the lower extremities, an improvement in the microcirculation of the thenar muscle as assessed by near infrared spectroscopy technique was observed
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