Indian Journal of Physiotherapy & Occupational Therapy-An International Journal

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Electrical Muscle Stimulation (EMS) Preserve Muscle Strength in Critically ill Patients- A Pilot Study


Affiliations
1 Singhania University, Pacheri, Rajasthan, India
2 Internal Medicine, Jaipur Golden Hospital, Rohini, New Delhi, India
3 Neurologist, Jaipur Golden Hospital, Rohini, New Delhi, India
     

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Introduction: Weakness that is acquired during hospitalization for critical illness is increasingly recognized as common and important clinical problem. Weakness acquired in the intensive care unit (ICU) and related acquired neuromuscular dysfunction occur in a large percentage of critically ill patients and are associated with increased morbidity and mortality.

Objective: This study was designed to investigate the effects of electrical muscle stimulation (EMS) on strength of muscle groups stimulated in critically ill patients.

Method: 134 subjects were recruited among the patient admitted in multidisciplinary intensive care units and randomly divided in to control and EMS group. Patients unable to understand or speak English and or Hindi due to language barrier or cognitive impairment prior to admission, unable to independently transfer from bed to chair at baseline prior to hospital admission, Patient with known history of primary systemic neuromuscular disease, vascular events, organ transplant, intracranial process that is associated with localizing weakness, transferred from another ICU after >2 consecutive days of mechanical ventilation, amputation of lower extremities were excluded from study.

Results: EMS group patients achieved higher MRC scores than controls in knee extensors (left ≤ 0.018), (right P ≤ 0.038) and ankle dorsiflexors (left ≤ 0.04), (right P ? 0.05)

Conclusions: EMS has beneficial effects on the strength of critically ill patients mainly affecting muscle groups stimulated, it can be considered as a potential effective means of muscle strength preservation and early mobilization in this patient population.


Keywords

Electrical Muscle Stimulation, Muscle Strength, CIPNM, CIM, ICU-AW
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  • De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al; Groupe de Reflexion et d’Etude des Neuromyopathies en Reanimation. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 2002;288(22):2859–2867.

  • de Letter MA, Schmitz PI, Visser LH, Verheul FA, Schellens RL, Op de Coul DA, van der Meche FG. Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit Care Med 2001;29(12):2281–2286.

  • Coakley JH, Nagendran K, Yarwood GD, Honavar M, Hinds CJ. Patterns of neurophysiological abnormality in prolonged critical illness. Intensive Care Med 1998;24(8):801–807.

  • Garnacho-Montero J, Madrazo-Osuna J, Garcia- Garmendia JL, Ortiz- Leyba C, Jimenez-Jimenez FJ, Barrero-Almodovar A, et al. Critical illness polyneuropathy: risk factors and clinical consequences: a cohort study in septic patients. Intensive Care Med 2001;27(8): 1288–1296.

  • Spitzer AR, Giancarlo T, Maher L, Awerbuch G, Bowles A. Neuromuscular causes of prolonged ventilator dependency. Muscle Nerve 1992;15(6):682–686.

  • Rudis MI, Guslits BJ, Peterson EL, Hathaway SJ, Angus E, Beis S, Zarowitz BJ. Economic impact of prolonged motor weakness complicating neuromuscular blockade in the intensive care unit. Crit Care Med 1996;24(10):1749–1756.

  • Latronico N, Peli E, Botteri M. Critical illness myopathy and neuropathy. Curr Opin Crit Care 2005;11(2):126–132.

  • Bednarik J, Lukas Z, Vondracek P. Critical illness polyneuromyopathy: the electrophysiological components of a complex entity. Intensive Care Med 2003;29(9):1505–1514.

  • Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001;345(19):1359–1367.

  • Tennila A, Salmi T, Pettila V, Roine RO, Varpula T, Takkunen O. Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis. Intensive Care Med 2000;26(9):1360–1363.

  • Rabuel C, Renaud E, Brealey D, Ratajczak P, Damy T, Alves A, et al. Human septic myopathy: induction of cyclooxygenase, heme oxygenase and activation of the ubiquitin proteolytic pathway. Anesthesiology 2004;101(3):583–590.

  • MacFarlane IA, Rosenthal FD. Severe myopathy after status asthmaticus (letter). Lancet 1977;2(8038):615.

  • Witt NJ, Zochodne DW, Bolton CF, Grand’Maison F, Wells G, Young GB, Sibbald WJ. Peripheral nerve function in sepsis and multiple organ failure. Chest 1991;99(1):176–184.

  • Knox AJ, Mascie-Taylor BH, Muers MF. Acute hydrocortisone myopathy in acute severe asthma. Thorax 1986;41(5):411–412.

  • Hund E, Genzwurker H, Bohrer H, Jakob H, Thiele R, Hacke W. Predominant involvement of motor fibres in patients with critical illness polyneuropathy. Br J Anaesth 1997;78(3):274–278.

  • Thiele RI, Jakob H, Hund E, Tantzky S, Keller S, Kamler M, et al. Sepsis and catecholamine support are the major risk factors for critical illness polyneuropathy after open heart surgery. Thorac Cardiovasc Surg 2000;48(3):145–150.

  • Garnacho-MonteroJ, Amaya-Villar R, Garcia- Garmendia JL,Madrazo- Osuna J, Ortiz-Leyba C. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med 2005;33(2):349–354.

  • Bolton CF. Sepsis and the systemic inflammatory response syndrome: neuromuscular manifestations. Crit Care Med 1996;24(8): 1408–1416.

  • Latronico N, Fenzi F, Recupero D, Guarneri B, Tomelleri G, Tonin P, et al. Critical illness myopathy and neuropathy. Lancet 1996; 347(9015):1579–1582.


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  • Electrical Muscle Stimulation (EMS) Preserve Muscle Strength in Critically ill Patients- A Pilot Study

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Authors

Dharam Pani Pandey
Singhania University, Pacheri, Rajasthan, India
Ram Babu
Internal Medicine, Jaipur Golden Hospital, Rohini, New Delhi, India
Uday Shanker Sharma
Neurologist, Jaipur Golden Hospital, Rohini, New Delhi, India

Abstract


Introduction: Weakness that is acquired during hospitalization for critical illness is increasingly recognized as common and important clinical problem. Weakness acquired in the intensive care unit (ICU) and related acquired neuromuscular dysfunction occur in a large percentage of critically ill patients and are associated with increased morbidity and mortality.

Objective: This study was designed to investigate the effects of electrical muscle stimulation (EMS) on strength of muscle groups stimulated in critically ill patients.

Method: 134 subjects were recruited among the patient admitted in multidisciplinary intensive care units and randomly divided in to control and EMS group. Patients unable to understand or speak English and or Hindi due to language barrier or cognitive impairment prior to admission, unable to independently transfer from bed to chair at baseline prior to hospital admission, Patient with known history of primary systemic neuromuscular disease, vascular events, organ transplant, intracranial process that is associated with localizing weakness, transferred from another ICU after >2 consecutive days of mechanical ventilation, amputation of lower extremities were excluded from study.

Results: EMS group patients achieved higher MRC scores than controls in knee extensors (left ≤ 0.018), (right P ≤ 0.038) and ankle dorsiflexors (left ≤ 0.04), (right P ? 0.05)

Conclusions: EMS has beneficial effects on the strength of critically ill patients mainly affecting muscle groups stimulated, it can be considered as a potential effective means of muscle strength preservation and early mobilization in this patient population.


Keywords


Electrical Muscle Stimulation, Muscle Strength, CIPNM, CIM, ICU-AW

References