Early neuromuscular electrical stimulation reduces the loss of muscle mass in critically ill patients – A within subject randomized controlled trial

• Published in: Journal of critical care Vol. 62; pp. 65 - 71
• Main Authors: Segers, Johan, Vanhorebeek, Ilse, Langer, Daniel, Charususin, Noppawan, Wei, Weili, Frickx, Bregje, Demeyere, Inge, Clerckx, Beatrix, Casaer, Michael, Derese, Inge, Derde, Sarah, Pauwels, Lies, Van den Berghe, Greet, Hermans, Greet, Gosselink, Rik
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2021; Elsevier Limited
• Subjects: Atrophy; Biopsy; Critical illness; Early mobilization; Electric stimulation; Gene expression; Intensive care; Morphology; Muscle weakness; Neuromuscular electrical stimulation; Patients; Physical therapy; Ultrasonic imaging; Belgium; Critical illness; Early mobilization; Muscle weakness; Electric stimulation; Physical therapy
• ISSN: 0883-9441; 1557-8615; 1557-8615
• DOI: 10.1016/j.jcrc.2020.11.018

To investigate the effect of Neuromuscular Electrical Stimulation (NMES) on muscle thickness, strength and morphological and molecular markers of the quadriceps. Adult critically ill patients with an expected prolonged stay received unilateral quadriceps NMES sessions for 7 consecutive days. Before and after the intervention period, quadriceps thickness was measured with ultrasound. After the intervention period, strength was assessed in cooperative patients and muscle biopsies were taken. Multivariable regression was performed to identify factors affecting muscle thickness loss. Muscle thickness decreased less in the stimulated leg (−6 ± 16% versus −12 ± 15%, p = 0.014, n = 47). Strength was comparable. Opioid administration, minimal muscle contraction and more muscle thickness loss in the non-stimulated muscle were independently associated with better muscle thickness preservation. Stimulated muscles showed a shift towards larger myofibers and higher MyHC-I gene expression. NMES did not affect gene expression of other myofibrillary proteins, MuRF-1 or atrogin-1. Signs of myofiber necrosis and inflammation were comparable for both muscles. NMES attenuated the loss of muscle mass, but not of strength, in critically ill patients. Preservation of muscle mass was more likely in patients receiving opioids, patients with a minimal muscle contraction during NMES and patients more prone to lose muscle mass. clinicaltrials.govNCT02133300 •Neuromuscular electrical stimulation diminishes the loss of muscle mass but not of muscle strength in critically ill patients.•Less reduction of muscle mass with NMES was observed in patients who are prone to lose muscle mass.•Obtaining a good muscle contraction was not compulsory for attenuating the loss of muscle mass.