NMES in Critically Ill Patients (NESCI)

Critically ill patients with a predicted prolonged ICU stay will receive neuromuscular electrical stimulation (NMES) of one quadriceps muscle. Whether the dominant or non-dominant side will be stimulated is chosen randomly by using opaque sealed envelopes. The patients will receive electrical stimulation for 1h for 7 consecutive days. The stimulated and non-stimulated side will be compared for it's thickness (by using ultrasound imaging), muscle strength if the patients are awake and cooperative (using the medical research council scale and handheld dynamometry) and a muscle biopsy will be taken. As a primary outcome the investigators hypothesize that electrical stimulation will preserve muscle mass with respect to the non-stimulated quadriceps. As secondary outcomes the investigators hypothesize that electrical stimulation can reduce muscle strength loss and leads to a better protein balance and thicker muscle fibers in the stimulated quadriceps.

Inclusion Criteria: All adult ICU patients with a predicted prolonged ICU stay Exclusion Criteria: Preexisting neuromuscular disease, polyneuropathy or myopathy (e.g. Guillain-Barré, myasthenia gravis, Amyotrophic Lateral Sclerosis, paraplegia, multiple sclerosis, …) Receiving neuromuscular blocking agents Musculoskeletal conditions of the pelvis and/or lower limb (e.g. fractures, skin disease ) Focal neurological conditions of the pelvis and/or lower limb Skin disease (e.g. burns) Presence of a pace-maker or defibrillator Hemodynamic or Respiratory Instability, active cardiac ischemia High fever (>39°) Pregnancy Brain death Intracranial pressure >20 mmHg An anticipated fatal outcome Psychiatric disorders or severe agitation Re-admission to the ICU

Segers J, Vanhorebeek I, Langer D, Charususin N, Wei W, Frickx B, Demeyere I, Clerckx B, Casaer M, Derese I, Derde S, Pauwels L, Van den Berghe G, Hermans G, Gosselink R. Early neuromuscular electrical stimulation reduces the loss of muscle mass in critically ill patients - A within subject randomized controlled trial. J Crit Care. 2021 Apr;62:65-71. doi: 10.1016/j.jcrc.2020.11.018. Epub 2020 Nov 28.