None listed
Conditions
Brief summary
Millions of patients are admitted to an intensive care unit (ICU) worldwide each year. Due to medical advances, more patients are surviving critical illness. Critical care survival comes at important costs to patient in terms of impaired physical function and quality of life and to society in terms of ongoing health care utilization and lost productivity, especially those who received prolonged mechanical ventilation. Critical illness polyneuromyopathy (CIPNM) is an acquired neuromuscular disorder observed in survivors of acute critical illness. This syndrome delays weaning from mechanical ventilation, increases the length of stay at the ICU, compromises rehabilitation and may result in a lifelong loss of function and in a reduction in quality of life. Emerging evidence is demonstrating that early rehabilitation may benefit ICU patients. Early mobilization is feasible and well tolerated, decreases both ICU and hospital length of stay and improves functional outcomes at hospital discharge. However, not all patients in the ICU can participate in physical activity because of sedation, impaired cognition, or insufficient physiological reserve. Electrical muscle stimulation (EMS) has been used as an alternative for disabled patients in chronic heart failure and chronic obstructive lung disease. Recent studies have showed that EMS may be well tolerated in ICU patients, preserving muscle mass and improving clinical outcomes. To our knowledge, there are no previous studies comparing the effect of combined EMS plus resistance exercise (RE) in ICU patients. We hypothesized that EMS plus RE, as an alternative form of exercise, could improve clinical outcomes of critically ill patients receiving mechanical ventilation. The scope of the present study is to assess the effect of EMS, RE, and EMS plus RE on the duration of mechanical ventilation in critically ill patients hospitalized in a multidisciplinary ICU.
Interventions
All patients eligible were randomized to a 55 minutes session of resistance exercise (RE), electrical muscle stimulation (EMS), combined exercise (EMS + RE) or usual care (control group, CG). We used sequentially numbered, opaque, sealed envelopes to maintain randomization allocation.
RE group started with passive mobilization; as patient was regaining consciousness, resistance was applied through active exercises (biceps, triceps and lower extremities) and resistance exercises with elastic band
All patients eligible were randomized to a 55 minutes session of resistance exercise (RE), electrical muscle stimulation (EMS), combined exercise (EMS + RE) or usual care (control group, CG). We used sequentially numbered, opaque, sealed envelopes to maintain randomization allocation. RE group started with passive mobilization; as patient was regaining consciousness, resistance was applied through active exercises (biceps, triceps and lower extremities) and resistance exercises with elastic band (Theraband, Mercury, Brazil). EMS group received daily EMS sessions of both lower extremities. EMS was implemented simultaneously on the vastus lateralis and vastus medialis. After shaving and skin cleaning, rectangular electrodes (90 x 50 mm) were placed on the motor points of vastus lateralis and vastus medialis of both legs. The stimulator (Industrial Electronic Technology Ltda, Brazil) delivered biphasic, symmetric impulses of 45 Hz, 400 micro seconds pulse duration, 12 seconds on (including 0,8 second rise time and 0,8 second fall time) and 6 seconds off, at intensities able to cause visible contractions. In case of doubt, contraction was confirmed by palpation of the muscles involved. The duration of the session was 55 minutes including 5 minutes for warm up and 5 minutes for recovery. Combined exercise group used both techniques, RE plus EMS at the same time. All patients received respiratory physiotherapy (positioning, mucus clearance techniques) during 30 minutes, twice a day, seven days per week . Interventions were continued until ICU discharge. RE will be applied once daily until ICU discharge.
Sponsors
University of Brasilia Brazil
Study design
Allocation
Randomised controlled trial
Intervention model
Factorial
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patients consecutively admitted to the multidisciplinary ICU of San Jose Hospital during the study period were considered for inclusion in the study. All patients who had been on mechanical ventilation for less than 72 hours, and were expected to continue for at least 24 hours, were included.
Exclusion criteria
preexisting neuromuscular disease (e.g. Myasthenia Gravis, Guillain-Barre disease), cardiopulmonary arrest, end-stage malignancy, raised intracranial pressure, or technical obstacles that did not allow the implementation of EMS such as bone fractures or skin lesions
Outcome results
None listed