Highlights
- •Combining physical therapy, NMES and high protein nutrition with standard care restored positive nitrogen balance in critically ill subjects.
- •The intervention group experienced less muscle lower extremity muscle loss (volume and cross-sectional area) when compared to standard care.
- •The intervention group experienced less delirium compared to the group who received standard care.
Abstract
Background
Neuromuscular electrical stimulation (NMES) with high protein supplementation (HPRO)
to preserve muscle mass and function has not been assessed in ICU patients. We compared
the effects of combining NMES and HPRO with mobility and strength rehabilitation (NMES+HPRO+PT)
to standardized ICU care.
Objectives
To assess the effectiveness of combined NMES+HPRO+PT in mitigating sarcopenia as evidenced
by CT volume and cross-sectional area when compared to usual ICU care. Additionally,
we assessed the effects of the combined therapy on select clinical outcomes, including
nutritional status, nitrogen balance, delirium and days on mechanical ventilation.
Methods
Participants were randomized by computer generated assignments to receive either NMES+HPRO+PT
or standard care. Over 14 days the standardized ICU care group (N = 23) received usual critical care and rehabilitation while the NMES+HPRO+PT group
(N = 16) received 30 min neuromuscular electrical stimulation of quadriceps and dorsiflexors
twice-daily for 10 days and mean 1.3 ± 0.4 g/kg body weight of high protein supplementation
in addition to standard care. Nonresponsive participants received passive exercises
and, once responsive, were encouraged to exercise actively. Primary outcome measures
were muscle volume and cross-sectional area measured using CT-imaging. Secondary outcomes
included nutritional status, nitrogen balance, delirium and days on mechanical ventilation.
Results
The NMES+HPRO+PT group (N = 16) lost less lower extremity muscle volume compared to the standard care group
(N = 23) and had larger mean combined thigh cross-sectional area. The nitrogen balance
remained negative in the standard care group, while positive on days 5, 9, and 14
in the NMES+HPRO+PT group. Standard care group participants experienced more delirium
than the NMES+HPRO+PT group. No differences between groups when comparing length of
stay or mechanical ventilation days.
Conclusions
The combination of neuromuscular electrical stimulation, high protein supplementation
and mobility and strength rehabilitation resulted in mitigation of lower extremity
muscle loss and less delirium in mechanically ventilated ICU patients.
Trial Registration: Clinicaltrials.gov identifier: NCT02509520. Registered July 28,
2015
Keywords
Abbreviations:
NMES (neuromuscular electrical stimulation), HPRO (high protein supplementation), PT (physical therapy), SC (standard care), LOS (length of stay), EMR (electronic medical record), NUTRIC (Nutrition Risk in Critically ill), MRC (medical research council), LTACH (long-term acute care hospital), PD (pulse duration), PR (pulse rate), CAM (confusion Assessment Method), CSA (cross-sectional area), SPPB (short physical performance battery)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 03, 2022
Accepted:
November 22,
2022
Received in revised form:
November 21,
2022
Received:
September 19,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
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- Exercise and nutrition in critically ill patients-What is the correct formula?Heart & Lung: The Journal of Cardiopulmonary and Acute CareVol. 58
- PreviewICU-acquired weakness is diagnosed in approximately 1 million mechanically ventilated patients annually.1 This weakness is secondary to multiple mechanisms including myopathy, neuropathy, deconditioning and protein malnutrition. In addition, ICU-acquired weakness is associated with decreased quality of life and increased mortality.2 Physical rehabilitation and nutritional support have the potential to improve muscle strength and help maintain functional status.
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