Abstract
ObjectiveCritically 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. DesignThis is an observational study. SettingThe setting is in the medical and surgical ICUs of a tertiary referral university hospital. PatientsFifty 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. InterventionTwenty-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). MeasurementsThe 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. ResultsIn 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. ConclusionsCritically 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.
Highlights
Autophagy is well known as one of the biogenic responses against various stresses, which possesses the beneficial roles for survival, but little is known about the dynamics and its significance during the septic condition
community-acquired pneumonia (CAP)-mediated antiinflammatory signals in vagal efferent nerve fibers result in the release of acetylcholine, which interacts with innate immune cells that express the nicotinic acetylcholine receptor subunit α7 (α7nAChR)
The aim of this study was to determine the effects of the α7nAChR-agonist cdp-choline on microcirculatory alterations during experimental endotoxemia
Summary
Autophagy is well known as one of the biogenic responses against various stresses, which possesses the beneficial roles for survival, but little is known about the dynamics and its significance during the septic condition. Conclusion The assessment of routine biomarkers (bilirubin, white blood cells and hemoglobin) may be a helpful tool in the decisionmaking process at the bedside, for the evaluation of early ICU admission of recoverable patients, as indicators of inflammatory response, organ dysfunction or catabolism level, and their significant predictive value on mortality. The purpose of this study was to ascertain the prognostic value of proadrenomedullin (pADM), measured in all patients admitted to the ICU of our hospital with a diagnosis of severe sepsis or septic shock during 1 year. The aim of the study is to evaluate life quality after trauma and to identify the most important needs of the patients, in order to improve the level of care after an ICU stay and to implement a faster and more effective reintegration into the active and productive society. We report the results of the baseline phase of this trial
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