Abstract
BackgroundNeuromuscular electrical stimulation (NMES) can be applied to critically ill patients. However, its results on muscle strength and functionality in patients with COVID-19 are unknown.ObjectiveEvaluate the effects of intervention with NMES on muscle mass and functionality of patients with severe COVID-19 associated with sepsis and septic shock.MethodsSeven patients with COVID-19 associated with sepsis or septic shock were selected, but only 5 patients completed all days of the intervention with NMES. The intervention was performed by a single physiotherapist on 7 consecutive days in a daily session of 40 min. The outcome measures were the femoris cross-sectional area; thickness of the anterior compartment of the quadriceps muscle; rectus femoris echogenicity; International Classification of Functioning, Disability, and Health (ICF)-muscle strength; PFIT-s, DEMMI, and the SOMS; feasibility, and safety. The patients were evaluated on days 1, 5, and 8.ResultsThe rectus femoris cross-sectional area decreased significantly from days 1 to 8, but showed maintenance of the thickness of the anterior compartment of the quadriceps muscle from days 1 to 8. The MRC score increased significantly from days 1 to 5 and kept this improvement until day 8. All patients showed an increase in the MRC score and reduction of the ICF-muscle strength, meaning improved muscle strength from days 1 to 8. The PFIT-s increased significantly from days 1 to 5 and improved until day 8 compared to day 5. DEMMI and SOMS score increased significantly on day 8 compared to days 1 and 5.ConclusionRehabilitation with NMES showed improvement in muscle strength and functionality of patients in this study with a potential protective effect on muscle mass loss in patients with critical COVID-19 associated with sepsis and septic shock. This study is the first report of the potential effects of neuromuscular electrical stimulation in patients with severe COVID-19 associated with sepsis and septic shock.
Highlights
The Coronavirus disease 2019 (COVID-19) is caused by novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) [1]
The present study aims to describe our clinical protocol in the treatment with neuromuscular electrical stimulation of patients with COVID-19 associated with sepsis and septic shock during their acute intensive care unit stay and to discuss intervention responses in skeletal muscle mass and functional performance
One patient stopped the treatment of neuromuscular electrical stimulation (NMES) and one patient died on day 8; data for these patients were not included in the outcomes of all patients; only their data are displayed in the Frontiers in Medicine | www.frontiersin.org
Summary
The Coronavirus disease 2019 (COVID-19) is caused by novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) [1]. Most patients have a mild form of the disease, but 5% of patients present severe lung injury and required intensive care [4] These patients may develop ICU-acquired weakness [5]. Studies using electrical muscle stimulation in septic patients have conflicting results depending on the titred stimulation frequency used. Carraro et al [10] suggest that frail persons post-COVID-19 infection with muscle weakness or persons in prolonged inactivity for pandemic-related restriction may benefit from the full-body exercise program associated with NMES. These effects are unknown in patients in the acute phase of the disease with severe COVID-19. Its results on muscle strength and functionality in patients with COVID-19 are unknown
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