Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial

Christina Routsi, Vasiliki Gerovasili, Ioannis Vasileiadis, Eleftherios Karatzanos, Theodore Pitsolis, Elli Tripodaki, Vasiliki Markaki, Dimitrios Zervakis, Serafim Nanas, Christina Routsi, Vasiliki Gerovasili, Ioannis Vasileiadis, Eleftherios Karatzanos, Theodore Pitsolis, Elli Tripodaki, Vasiliki Markaki, Dimitrios Zervakis, Serafim Nanas

Abstract

Introduction: Critical illness polyneuromyopathy (CIPNM) is a common complication of critical illness presenting with muscle weakness and is associated with increased duration of mechanical ventilation and weaning period. No preventive tool and no specific treatment have been proposed so far for CIPNM. Electrical muscle stimulation (EMS) has been shown to be beneficial in patients with severe chronic heart failure and chronic obstructive pulmonary disease. Aim of our study was to assess the efficacy of EMS in preventing CIPNM in critically ill patients.

Methods: One hundred and forty consecutive critically ill patients with an APACHE II score >or= 13 were randomly assigned after stratification to the EMS group (n = 68) (age:61 +/- 19 years) (APACHE II:18 +/- 4, SOFA:9 +/- 3) or to the control group (n = 72) (age:58 +/- 18 years) (APACHE II:18 +/- 5, SOFA:9 +/- 3). Patients of the EMS group received daily EMS sessions. CIPNM was diagnosed clinically with the medical research council (MRC) scale for muscle strength (maximum score 60, <48/60 cut off for diagnosis) by two unblinded independent investigators. Duration of weaning from mechanical ventilation and intensive care unit (ICU) stay were recorded.

Results: Fifty two patients could be finally evaluated with MRC; 24 in the EMS group and 28 in the control group. CIPNM was diagnosed in 3 patients in the EMS group as compared to 11 patients in the control group (OR = 0.22; CI: 0.05 to 0.92, P = 0.04). The MRC score was significantly higher in patients of the EMS group as compared to the control group [58 (33 to 60) vs. 52 (2 to 60) respectively, median (range), P = 0.04). The weaning period was statistically significantly shorter in patients of the EMS group vs. the control group [1 (0 to 10) days vs. 3 (0 to 44) days, respectively, median (range), P = 0.003].

Conclusions: This study suggests that daily EMS sessions prevent the development of CIPNM in critically ill patients and also result in shorter duration of weaning. Further studies should evaluate which patients benefit more from EMS and explore the EMS characteristics most appropriate for preventing CIPNM.

Trial registration number: ClinicalTrials.gov NCT00882830.

Figures

Figure 1
Figure 1
Schediagram of patients admitted to the ICU and the randomization process. APACHE, Acute Physiology and Chronic Health Evaluation; EMS, electrical muscle stimulation.
Figure 2
Figure 2
Difference in the MRC scale for muscle strength between patients assigned to the EMS group as compared with patients assigned to the control group (mean ± 2 standard errors). P = 0.04. EMS, electrical muscle stimulation; MRC, Medical Research Council.
Figure 3
Figure 3
Kaplan-Meier curves of the probability of remaining under mechanical ventilation after the onset of weaning. (a) Duration of mechanical ventilation (log rank test, P = 0.075). (b) Days off mechanical ventilation (log rank test, P = 0.003). (c) Weaning period (short-term): no need for mechanical ventilation for the next 48 hours (log rank test, P = 0.003). (d) Weaning period (long-term): no need for mechanical ventilation until ICU discharge (log rank test, P = 0.003) for patients in the electrical muscle stimulation (EMS) group as compared with those in the control group.
Figure 4
Figure 4
Kaplan-Meier curves comparing the ICU length of stay in patients with and without critical illness polyneuromyopathy (CIPNM; log-rank test, P = 0.01) and between patients assigned to the electrical muscle stimulation group as compared with patients assigned to the control group (log-rank test, P = 0.11).

References

    1. Schweickert WD, Hall J. ICU-acquired weakness. Chest. 2007;131:1541–1549. doi: 10.1378/chest.06-2065.
    1. De Jonghe B, Bastuji-Garin S, Sharshar T, Outin H, Brochard L. Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med. 2004;30:1117–1121. doi: 10.1007/s00134-004-2174-z.
    1. Ali NA, O'Brien JM Jr, Hoffmann SP, Phillips G, Garland A, Finley JC, Almoosa K, Hejal R, Wolf KM, Lemeshow S, Connors AF Jr, Marsh CB. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med. 2008;178:261–268. doi: 10.1164/rccm.200712-1829OC.
    1. De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, Cerf C, Renaud E, Mesrati F, Carlet J, Raphaël JC, Outin H, Bastuji-Garin S. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288:2859–2867. doi: 10.1001/jama.288.22.2859.
    1. Bolton CF. Sepsis and the systemic inflammatory response syndrome: neuromuscular manifestations. Crit Care Med. 1996;24:1408–1416. doi: 10.1097/00003246-199608000-00022.
    1. Amaya-Villar R, Garnacho-Montero J, García-Garmendía JL, Madrazo-Osuna J, Garnacho-Montero MC, Luque R, Ortiz-Leyba C. Steroid-induced myopathy in patients intubated due to exacerbation of chronic obstructive pulmonary disease. Intensive Care Med. 2005;31:157–161. doi: 10.1007/s00134-004-2509-9.
    1. Garnacho-Montero J, Madrazo-Osuna J, García-Garmendia JL, Ortiz-Leyba C, Jiménez-Jiménez FJ, Barrero-Almodóvar A, Garnacho-Montero MC, Moyano-Del-Estad MR. Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med. 2001;27:1288–1296. doi: 10.1007/s001340101009.
    1. Berghe G Van den, Wouters PJ, Bouillon R, Weekers F, Verwaest C, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P. Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med. 2003;31:359–366. doi: 10.1097/01.CCM.0000045568.12881.10.
    1. Nanas S, Kritikos K, Angelopoulos E, Siafaka A, Tsikriki S, Poriazi M, Kanaloupiti D, Kontogeorgi M, Pratikaki M, Zervakis D, Routsi C, Roussos C. Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit. Acta Neurol Scand. 2008;118:175–181. doi: 10.1111/j.1600-0404.2008.00996.x.
    1. de Letter MA, Schmitz PI, Visser LH, Verheul FA, Schellens RL, Op de Coul DA, Meché FG van der. Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit Care Med. 2001;29:2281–2286. doi: 10.1097/00003246-200112000-00008.
    1. Nuhr MJ, Pette D, Berger R, Quittan M, Crevenna R, Huelsman M, Wiesinger GF, Moser P, Fialka-Moser V, Pacher R. Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure. Eur Heart J. 2004;25:136–143. doi: 10.1016/j.ehj.2003.09.027.
    1. Neder JA, Sword D, Ward SA, Mackay E, Cochrane LM, Clark CJ. Home based neuromuscular electrical stimulation as (COPD) patients with chronic obstructive pulmonary disease a new rehabilitative strategy for severely disabled. Thorax. 2002;57:333–337. doi: 10.1136/thorax.57.4.333.
    1. Vivodtzev I, Pépin JL, Vottero G, Mayer V, Porsin B, Lévy P, Wuyam B. Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely deconditioned and malnourished COPD. Chest. 2006;129:1540–1548. doi: 10.1378/chest.129.6.1540.
    1. Sillen MJ, Janssen PP, Akkermans MA, Wouters EF, Spruit MA. Effects of neuromuscular electrical stimulation of muscles of ambulation in patients with chronic heart failure or COPD. A systematic review of the English-language literature. Chest. 2009;136:44–61. doi: 10.1378/chest.08-2481.
    1. Gerovasili V, Tripodaki E, Karatzanos E, Pitsolis T, Markaki V, Zervakis D, Routsi C, Roussos C, Nanas S. Short term systemic effect of electrical muscle stimulation in critically ill patients. Chest. 2009;136:1249–1256. doi: 10.1378/chest.08-2888.
    1. Routsi C, Gerovasili V, Zervakis D, Karatzanos E, Papadopoulos E, Pitsolis T, Tripodaki E, Manetos C, Markaki V, Nanas S. Electrical muscle stimulation prevents critical illness polyneuromyopathy in ICU patients-A randomized parallel intervention trial. [abstract] Intensive Care Med. 2009;35:S133.
    1. Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26:1793–1800.
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–829. doi: 10.1097/00003246-198510000-00009.
    1. Moreno RP, Metnitz PGH, Almeida E, Jordan B, Bauer P, Campos RA, Lapichino G, Edbrooke D, Capuzzo M, Le Gall JL. SAPS 3 From the evaluation of the patient to the evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 2005;31:1345–1355. doi: 10.1007/s00134-005-2763-5.
    1. De Jonghe B, Bastuji-Garin S, Durand MC, Malissin I, Rodrigues P, Cerf C, Outin H, Sharshar T. Groupe de Réflexion et d'Etude des Neuromyopathies en Réanimation. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med. 2007;35:2007–2015. doi: 10.1097/01.ccm.0000281450.01881.d8.
    1. Kleyweg RP, Meché FG van der, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome. Muscle Nerve. 1991;14:1103–1109. doi: 10.1002/mus.880141111.
    1. Hermans G, Wilmer A, Meersseman W, Milants I, Wouters PJ, Bobbaers H, Bruyninckx F, Berghe G Van den. Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit. Am J Respir Crit Care Med. 2007;175:480–489. doi: 10.1164/rccm.200605-665OC.
    1. Zanotti E, Felicetti G, Maini M, Fracchia C. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Chest. 2003;124:292–296. doi: 10.1378/chest.124.1.292.
    1. Gerovasili V, Stefanidis K, Vitzilaios K, Karatzanos E, Politis P, Koroneos A, Chatzimichail A, Routsi C, Roussos C, Nanas S. Electrical muscle stimulation preserves the muscle mass of critically ill patients. A randomized study. Crit Care. 2009;13:R161. doi: 10.1186/cc8123.
    1. Bouletreau P, Patricot MC, Saudin F, Guiraud M, Mathian B. Effects of intermittent electrical stimulations on muscle catabolism in intensive care patients. J Parenter Enteral Nutr. 1987;11:552–555. doi: 10.1177/0148607187011006552.
    1. Pérez M, Lucia A, Santalla A, Chicharro JL. Effects of electrical stimulation on VO2 kinetics and delta efficiency in healthy young men. Br J Sports Med. 2003;37:140–143. doi: 10.1136/bjsm.37.2.140.
    1. Ostrowski K, Rohde T, Zacho M, Asp S, Pedersen BK. Evidence that interleukin-6 is produced in human skeletal muscle during prolonged running. J Physiol. 1998;508:949–953. doi: 10.1111/j.1469-7793.1998.949bp.x.
    1. Hirose L, Nosaka K, Newton M, Laveder A, Kano M, Peake J, Suzuki K. Changes in inflammatory mediators following eccentric exercise of the elbow flexors. Exerc Immunol Rev. 2004;10:75–90.
    1. Jonsdottir IH, Schjerling P, Ostrowski K, Asp S, Richter EA, Pedersen BK. Muscle contractions induce interleukin-6 mRNA production in rat skeletal muscles. J Physiol. 2000;528:157–163. doi: 10.1111/j.1469-7793.2000.00157.x.
    1. Ono T, Maekawa K, Watanabe S, Oka H, Kuboki T. Muscle contraction accelerates IL-6 mRNA expression in the rat masseter muscle. Arch Oral Biol. 2007;52:479–486. doi: 10.1016/j.archoralbio.2006.10.025.
    1. Hamaoka T, McCully KK, Quaresima V, Yamamoto K, Chance B. Near-infrared spectroscopy/imaging for monitoring muscle oxygenation and oxidative metabolism in healthy and diseased humans. J Biomed Opt. 2007;12:062105. doi: 10.1117/1.2805437.
    1. Tsuchimochi H, Hayes SG, McCord JL, Kaufman MP. Both central command and exercise pressor reflex activate cardiac sympathetic nerve activity in decerebrate cats. Am J Physiol Heart Circ Physiol. 2009;296:H1157–1163. doi: 10.1152/ajpheart.01219.2008.
    1. Pimenta Ada S, Lambertucci RH, Gorjão R, Silveira Ldos R, Curi R. Effect of a single session of electrical stimulation on activity and expression of citrate synthase and antioxidant enzymes in rat soleus muscle. Eur J Appl Physiol. 2007;102:119–126. doi: 10.1007/s00421-007-0542-4.
    1. Visser LH. Critical illness polyneuropathy and myopathy: Clinical features, risk factors and prognosis. Eur Neurol. 2006;13:1203–1212. doi: 10.1111/j.1468-1331.2006.01498.x.
    1. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, Penley L, Howard A, Dixon L, Leach S, Small R, Hite RD, Haponik E. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36:2238–2243. doi: 10.1097/CCM.0b013e318180b90e.
    1. Chiang LL, Wang LY, Wu CP, Wu HD, Wu YT. Effects of physical training on functional status in patients with prolonged mechanical ventilation. Physical Therapy. 2006;86:1271–1281. doi: 10.2522/ptj.20050036.
    1. Nava S. Rehabilitation of patients admitted to a respiratory intensive care unit. Arch Phys Med Rehab. 1998;79:849–854. doi: 10.1016/S0003-9993(98)90369-0.
    1. Porta R, Vitacca M, Gile LS, Clini E, Bianchi L, Zanotti E, Ambrosino N. Supported arm training in patients recently weaned from mechanical ventilation. Chest. 2005;128:2511–2520. doi: 10.1378/chest.128.4.2511.
    1. Martin AD, Davenport PD, Franceschi AC, Harman E. Use of inspiratory muscle strength training to facilitate ventilator weaning: A series of 10 consecutive patients. Chest. 2002;122:192–196. doi: 10.1378/chest.122.1.192.
    1. Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, Hermans G, Decramer M, Gosselink R. Early exercise in dritically ill patients enhances short-term functional recovery. Crit Care Med. 2009;37:2499–2505. doi: 10.1097/CCM.0b013e3181a38937.
    1. Garnacho-Montero J, Amaya-Villar R, García-Garmendía 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;33:349–354. doi: 10.1097/01.CCM.0000153521.41848.7E.
    1. Rennie MJ. Anabolic resistance in critically ill patients. Crit Care Med. 2009;37:S398–S399. doi: 10.1097/CCM.0b013e3181b6ec1f.
    1. De Benedetti F, Alonzi T, Moretta A, Lazzaro D, Costa P, Poli V, Martini A, Ciliberto G, Fattori E. Interleukin 6 causes growth factor impairment in transgenic mice through a decrease in insulin like growth factor-I. A model for stunted growth in children with chronic inflammation. J Clin Invest. 1997;99:643–650. doi: 10.1172/JCI119207.
    1. Fischer CP. Interleukin 6 in acute exercise and training; what is the biological relevance. Exerc Immunil Rev. 2006;12:6–33.

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