High-vs medium-frequency neuromuscular electrical stimulation protocols on muscle mass in Intensive Care Unit patients, a pilot study
Published:
Oct 4, 2023
Keywords:
Early rehabilitation muscle mass NMES frequency electrical muscle stimulation ICU
Abstract
Aim: The aim of the present study was to investigate whether a high-frequency (HF) neuromuscular electrical stimulation (NMES) protocol could result in a smaller loss of muscle mass than a moderate-frequency (MF) protocol in ICU patients.
Methods and materials: In this randomized pilot control trial, patients of the two intervention groups followed daily NMES sessions from the day of ICU admission until the tenth day. All study groups received physiotherapy in terms of usual care. Muscle layer thickness was assessed with ultrasound in the vastusintermedius (VI) and rectus femoris (RF) muscle to evaluate changes in muscle mass.
Results: Totally 58 patients were allocated into three groups and 29 were finally analyzed (control: 10, MF: 12, HF: 7). Significant differences (p=0.05) between control and pooled NMES groups were observed for the right RF and VI. Significant differences in favor of HF vs MF group were observed for the left RF (3.6±15.3 vs 7.2±7.9% respectively, p=0.04). No differences were found regarding the number of sessions and presence of oedema (p>0.05), while strength of contraction during sessions tended to be somewhat higher in the HF (p=0.09).
Conclusion: HF may be more effective than MF to prevent muscle mass loss in ICU patients. More studies are needed to determine the optimal NMES characteristics.
Article Details
- How to Cite
-
Georgopoulos, C., Katsogianni, A., Patsaki, E., Sidiras, G., Vasileiadis, I., Magira, E., Nanas, S., & Karatzanos, L. (2023). High-vs medium-frequency neuromuscular electrical stimulation protocols on muscle mass in Intensive Care Unit patients, a pilot study. Health & Research Journal, 9(4), 219–236. https://doi.org/10.12681/healthresj.34252
- Section
- Original Articles
Copyright notice:
The journal "Health and Research Journal" reserves the rights for copyright of the content of the website and also the copyright of the articles published.
By virtue of their appearance in this journal, the articles are free to be used for non-commercial purposes. However, the articles cannot and must not be used in anyway, published elsewhere or modified without any reference to the author and the first publication of the article.
Downloads
Download data is not yet available.
References
Stevens RD, Marshall SA, Cornblath DR, Hoke A, Needham DM, de Jonghe B. A framework for diagnosing and classify-ing intensive care unit-acquired weakness. Crit Care Med. 2009;37:S299-308. doi: 10.1097/CCM.0b013e3181b6ef67.
Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P. Acute skeletal muscle wasting in crit-ical illness. JAMA. 2013;310:1591-600. doi: 10.1001/jama.2013.278481.
De Jonghe B, Bastuji-Garin S, Durand MC, Malissin I, Ro-drigues P et al. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med. 2007;359:2007-15. doi:10.1097/01.ccm.0000281450.01881.d8.
Nanas S, Kritikos K, Angelopoulos E, Siafaka A, Tsikriki S, Poriazi M et al. Predisposing factors for critical illness poly-neuromyopathy in a multidisciplinary intensive care unit. ActaNeurol Scand. 2008;118(3):175-81.doi:10.1111/j.1600-0404.2008.00996.
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Paw-lik AJ, Esbrook CL et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874-82. doi:10.1016/S0140-6736(09)60658-9.
Rodriguez PO, Setten M, Maskin LP, Bonelli I, Vidomlansky SR, Attie S. Muscle weakness in septic patients requiring mechanical ventilation: protective effect of transcutaneous neuromuscular electrical stimulation. J Crit Care. 2012;273:319.e1-8.doi:10.1016/j.jcrc.2011.04.010.
Gerovasili V, Stefanidis K, Vitzilaios K, Karatzanos E, Politis P, Koroneos A et al. Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study. Crit Care. 2009;135:R161.doi: 10.1186/cc8123.
Maffiuletti NA, Roig M, Karatzanos E, Nanas S. Neuromus-cular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review. BMC Med. 2013 23;11:137. doi: 10.1186/1741-7015-11-137.
Hirose T, Shiozaki T, Shimizu K, Mouri T, Noguchi K, Ohni-shi M et al. The effect of electrical muscle stimulation on the prevention of disuse muscle atrophy in patients with consciousness disturbance in the intensive care unit. J Crit Care. 2013;284:536.e1-7. doi:10.1016/j.jcrc.2013.02.010.
Routsi C, Gerovasili V, Vasileiadis I, Karatzanos E, Pitsolis T, Tripodaki E et al. Electrical muscle stimulation prevents crit-ical illness polyneuromyopathy: a randomized parallel in-tervention trial. Crit Care. 2010;142:R74. doi: 10.1186/cc8987.
Gerovasili V, Tripodaki E, Karatzanos E, Pitsolis T, Markaki V, Zervakis D et al. Short-term systemic effect of electrical muscle stimulation in critically ill patients. Chest. 2009;136(5):1249-1256. doi: 10.1378/chest.08-2888.
Stefanou C, Karatzanos E, Mitsiou G, Psarra K, Angelopou-los E, Dimopoulos S et al. Neuromuscular electrical stimula-tion acutely mobilizes endothelial progenitor cells in criti-cally ill patients with sepsis. Ann Intensive Care. 2016;11. doi: 10.1186/s13613-016-0123-y.
Angelopoulos E, Karatzanos E, Dimopoulos S, Mitsiou G, Stefanou C, Patsaki I et al. Acute microcirculatory effects of medium frequency versus high frequency neuromuscular electrical stimulation in critically ill patients - a pilot study. Ann Intensive Care. 2013;193(1):39. doi:10.1186/2110-5820-3-39.
Vivodtzev I, Pépin JL, Vottero G, Mayer V, Porsin B, Lévy P et al. Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severe-ly deconditioned and malnourished COPD. Chest. 2006;129(6):1540-8. doi:10.1378/chest.129.6.1540.
Vivodtzev I, Debigaré R, Gagnon P, Mainguy V, Saey D, Dubé A et al. Functional and muscular effects of neuro-muscular electrical stimulation in patients with severe COPD: a randomized clinical trial. Chest. 2012;141(3):716-725. doi:10.1378/chest.11-0839.
Quittan M, Wiesinger GF, Sturm B, Puig S, Mayr W, Sochor A et al. Improvement of thigh muscles by neuromuscular electrical stimulation in patients with refractory heart fail-ure: a single-blind, randomized, controlled trial. Am J Phys Med Rehabil. 2001;80(3):206-14. doi:10.1097/00002060-200103000-00011.
Quittan M, Sochor A, Wiesinger GF, Kollmitzer J, Sturm B, Pacher R et al. Strength improvement of knee extensor muscles in patients with chronic heart failure by neuro-muscular electrical stimulation. Artif Organs. 1999;23(5):432-5. doi:10.1046/j.1525-1594.1999.06372.x.
Mettler JA, Magee DM, Doucet BM. High-Frequency Neu-romuscular Electrical Stimulation Increases Anabolic Sig-naling. Med Sci Sports Exerc. 2018;50(8):1540-1548. doi:10.1249/MSS.0000000000001610.
Gorgey AS, Mahoney E, Kendall T, Dudley GA. Effects of neuromuscular electrical stimulation parameters on specif-ic tension. Eur J Appl Physiol. 2006;97(6):737-44. doi: 10.1007/s00421-006-0232-7.
Kashyap R, Sherani KM, Dutt T, Gnanapandithan K, Sagar M, Vallabhajosyula S et al. Current Utility of Sequential Or-gan Failure Assessment Score: A Literature Review and Fu-ture Directions. Open Respir Med J. 2021;13;15:1-6. doi:10.2174/1874306402115010001.
Gondin J, Brocca L, Bellinzona E, D'Antona G, Maffiuletti NA, Miotti D et al. Neuromuscular electrical stimulation training induces atypical adaptations of the human skeletal muscle phenotype: a functional and proteomic analysis. J ApplPhysiol (1985). 2011;110(2):433-50. doi: 10.1152/japplphysiol.00914.2010.
Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimula-tion in critically ill patients. J Crit Care. 2014;29(6):1082-8. doi:10.1016/j.jcrc.2014.06.024.
Campbell IT, Watt T, Withers D, England R, Sukumar S, Keegan MA et al. Muscle thickness, measured with ultra-sound, may be an indicator of lean tissue wasting in multi-ple organ failure in the presence of edema. Am J ClinNutr. 1995;62(3):533-9. doi:10.1093/ajcn/62.3.533.
Nuhr MJ, Pette D, Berger R, Quittan M, Crevenna R, Huels-man M et al. Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure. Eur Heart J. 2004;25(2):136-43. doi:10.1016/j.ehj.2003.09.027.
Maillefert JF, Eicher JC, Walker P, Dulieu V, Rouhier-Marcer I, Branly F et al. Effects of low-frequency electrical stimula-tion of quadriceps and calf muscles in patients with chron-ic heart failure. J CardiopulmRehabil. 1998;18(4):277-82. doi:10.1097/00008483-199807000-00004.
Vivodtzev I, Pépin JL, Vottero G, Mayer V, Porsin B, Lévy P et al. Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severe-ly deconditioned and malnourished COPD. Chest. 2006;129(6):1540-8. doi:10.1378/chest.129.6.1540.
Bourjeily-Habr G, Rochester CL, Palermo F, Snyder P, Mohsenin V. Randomised controlled trial of transcutane-ous electrical muscle stimulation of the lower extremities in patients with chronic obstructive pulmonary disease. Thor-ax. 2002;57(12):1045-9. doi:10.1136/thorax.57.12.1045.
Neder JA, Sword D, Ward SA, Mackay E, Cochrane LM, Clark CJ. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled pa-tients with chronic obstructive pulmonary disease (COPD). Thorax. 2002;57(4):333-7. doi:10.1136/thorax.57.4.333.
Silva PE, de Cassia MarquetiR,Livino-de-CarvalhoK,SouzaVC,DantasLO,Cipriano G et al. Neuromus-cular electrical stimulation in critically ill traumatic brain in-jury patients attenuates muscle atrophy,neurophysiological disorders, and weakness: a randomized controlled trial. J Intensive Care.2019;12;7:59. doi:10.1186/s40560-019-0417-x.
Chaplin EJ, Houchen L, Greening NJ, Harvey-Dunstan T, Morgan MD, Steiner MC et al. Neuromuscular stimulation of quadriceps in patients hospitalised during an exacerba-tion of COPD: a comparison of low (35 Hz) and high (50 Hz) frequencies. Physiother Res Int. 2013;18(3):148-56. doi: 10.1002/pri.1541.
Sillen MJ, Wouters EF, Franssen FM, Meijer K, Stakenborg KH, Spruit MA. Oxygen uptake, ventilation, and symptoms during low-frequency versus high-frequency NMES in COPD: a pilot study. Lung. 2011;189(1):21-6. doi: 10.1007/s00408-010-9265-0.
Sillen MJ, Franssen FM, Delbressine JM, Vaes AW, Wouters EF, Spruit MA. Efficacy of lower-limb muscle training mo-dalities in severely dyspnoeicindividuals with COPD and quadriceps muscle weakness: results from the DICES trial. Thorax. 2014;69(6):525-31. doi: 10.1136/thoraxjnl-2013-204388.
Sbruzzi G, Schaan BD, Pimentel GL, Signori LU, Da Silva AN, Oshiro MS et al. Effects of low frequency functional electri-cal stimulation with 15 and 50 Hz on muscle strength in heart failure patients. DisabilRehabil. 2011;33(6):486-93. doi:10.3109/09638288.2010.498551.
Falavigna LF, Silva MG, Freitas AL, Silva PF, PaivaJúnior MD, de Castro CM et al. Effects of electrical muscle stimulation early in the quadriceps and tibialis anterior muscle of criti-cally ill patients. Physiother Theory Pract. 2014;30(4):223-8. doi:10.3109/09593985.2013.869773.
Dirks ML, Hansen D, Van Assche A, Dendale P, Van Loon LJ. Neuromuscular electrical stimulation prevents muscle wasting in critically ill comatose patients. ClinSci (Lond). 2015;128(6):357-65. doi: 10.1042/CS20140447.
Strasser EM, Stättner S, Karner J, Klimpfinger M, Freynhofer M, Zaller V. Neuromuscular electrical stimulation reduces skeletal muscle protein degradation and stimulates insulin-like growth factors in an age- and current-dependent manner: a randomized, controlled clinical trial in major ab-dominal surgical patients. Ann Surg. 2009;249(5):738-43. doi: 10.1097/SLA.0b013e3181a38e71.
Weber-Carstens S, Schneider J, Wollersheim T, Assmann A, Bierbrauer J, Marg A et al. Critical illness myopathy and GLUT4: significance of insulin and muscle contraction. Am J RespirCrit Care Med. 2013;15;187(4):387-96. doi:10.1164/rccm.201209-1649OC.
Fischer A, Spiegl M, Altmann K, Winkler A, Salamon A, Themessl-Huber M et al. Muscle mass, strength, and func-tional outcomes in critically ill patients after cardiothoracic surgery: does neuromuscular electrical stimulation help? The Catastim 2 randomized controlled trial. Crit Care. 2016;29;20:30. doi:10.1186/s13054-016-1199-3.
