Dissertation committee:
Νανάς Σεραφείμ, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κοτανίδου Αναστασία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ρούτση Χριστίνα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Στράντζαλης Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Βασιλειάδης Ιωάννης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ροβίνα Νικολέτα, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Φιλίππου Αναστάσιος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Muscle mass loss has been a contributing factor to intensive care unit acquired weakness (ICUaw), a common complication in critically ill patients. Although research evidence supports neuromuscular electrical stimulation (NMES) as a means of early mobilization, there are not any data on the effects of different protocols on muscle mass loss. This study aimed to explore the effects of different ΝΜΕS protocols on muscle mass in ICU patients.
The present study was a prospective, randomized study conducted in three multidisciplinary ICU. Fifty eight patients were randomized either to control group (10 patients) or one of two intervention groups (40 patients); the later ones; the medium frequency (MF) group (45 Hz, 400μsec, 12/6 sec on/off 45 min) and the high frequency (HF) group (75 Hz, 400μsec, 5/21 sec on/off, 45 min). NMES was applied daily, from admission until the 10th day, on vastus lateralis, vastus medialis and peroneus longus of both lower extremities. The contraction strength of the stimulated muscles was evaluated in each session with a scale ranging from 0 (no contraction) to 4 (full extension). Alterations of muscle mass were evaluated with ultrasound measurements, performed on admission and after 10 days, to quantify the muscle layer thickness of the rectus femoris and vastus intermedius. Twelve patients of the MF group ,7 patients in the HF group, and 10 patients in the control group were finally evaluated.
Νo difference (p>0,05) between control and NMES groups was observed for age (45±25 vs 55±16years), gender(7/3 vs 13/6 male/female), SOFA score (6±3 vs 7±3), APACHE II score (13±8 vs 13±6) and SAPS III score (46±15 vs 54±15) at ICU admission. No difference (p>0,05) between MF and HF groups (respectively) was observed for age (55±15 vs 55±13 years), gender (7/5 vs 6/1 male/female), SOFA score (7±3 vs 6±3), APACHE II score (15±6 vs 10±6) but there was a difference (p=0,04) for SAPS III score (60±12 vs 46±15) at ICU admission.
In relation to right leg, the diameter of rectus femoris muscle decreased in the control group by 13,3±9,3% (p=0,003) and in the NMES group by 5,9±11% (p=0,008). The diameter of vastus intermedius muscle decreased in the control group 25,3±15,3% (p=0,006) and in the NMES group 12,9±21,2% (p=0,019) In concern to left leg, the diameter of rectus femoris muscle decreased in the control group 10,3±11,0% (p=0,024) and in the NMES group 4,7±12,4% (p=0,053). The diameter of vastus intermedius muscle decreased 17,7±12,6% (p=0,059) in the control group and in the NMES group 17,7±12,6% (p=0,059). Only for right leg there were significant (p<0,05) between- group differences.
In relation to right leg, the diameter of rectus femoris muscle decreased in the MF group 7,2±7,9% (p=0,01) and in the HF group 3,6±15,34% (p=0,83). The diameter of vastus intermedius muscle decreased in the MF group 17,0±16,6% (p=0,02) and in the HF group6,6±27,3% (p=0,44). In concern to left leg, the diameter of rectus femoris muscle decreased22,8±12,9% (p=0,06) in the MF group and increased 1,5±8,8%, (p=0,67) in the HF group. The diameter of vastus intermedius muscle decreased in the control group and in the NMES group. Only for left rectus femoris there was significant (p<0,05) between- group differences.
No significant differences between the MF and HF groups (respectively) were also observed for percentage (89,2±19,2% vs 95,2±20,2%, p=0,16) of NMES sessions completed and strength of contraction (2,3±0,7 vs 2,9±0,7 p=0,09).
There were some evidence that HF protocol may be more effective than MF protocol in preserving muscle mass in critically ill patients. These findings, however, are underpowered to reach definite conclusions. Further studies are needed for the optimal protocol to be established.
