NMES Role to Prevent Respiratory Muscle Weakness in Critically Ill Patients and Its Association to Changes in Myokines.
Muscle Weakness or Atrophy, Mechanical Ventilation Complication, Electrical Stimulations
About this trial
This is an interventional prevention trial for Muscle Weakness or Atrophy focused on measuring Neuromuscular electrical stimulation, Critical care
Eligibility Criteria
Inclusion Criteria:
- Consecutively admission to Christus ICU between March 2021 and December 2021.
- Connected to invasive MV within the previous 24-48 hours
- Deep sedation [non-cooperative state; Sedation-Agitation Scale (SAS) 1 or 2].
- ICU-acquired weakness risk (One of the following risk factors: the need for invasive MV, sepsis, hyperglycemia, APACHE II admission score >13 pts, use of corticosteroids, and/or muscle inactivity due to deep sedation).
- Written informed consent provided by patient/surrogate
Exclusion Criteria:
- Age < 18 years
- Pregnancy
- Obesity (Body Mass Index >35 kg/m2)
- Pre-existing Neuromuscular diseases (e.g., myasthenia Gravis, Guillain-Barré disease)
- Diseases with systemic vascular involvement such as systemic lupus erythematosus.
- Use of neuromuscular blockers
- Technical obstacles to the implementation of NMES such as bone fractures or skin lesions (e.g., burns)
- End-stage malignancy
- Presence of cardiac pacemakers
- Diagnosis of brain death.
Sites / Locations
- Pontificia Universidad Católica de ChileRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
NMES group
Control
NMES will be implemented simultaneously on quadriceps femoris muscles of both lower limbs using an electrical stimulator (TRAINFES 6 ADVANCED, Biomedical devices Spa, Santiago, Chile). Four rubber surface electrodes will be placed over motor points. However, since the electrodes will cover big proportion of muscle surface, anatomical distribution of the belly muscle plus visible contraction of it will be considered for correct setting. The stimulation will be delivered by biphasic current, symmetric (compensated) impulses of 45-50 Hz frequency, 400 μsec pulse duration. With a stimulus duration of 25 minutes, and an on-off programming of 5 seconds on (including 0.8 second rise time, 3.4 seconds of plateau and 0.8 second of fall time) and 5 seconds off, at current intensities able to cause maximal visible contractions. The session duration will be 30 minutes and will be applied twice a day.
Sham NMES will not be provided. Standard care won´t be altered and passive mobilization will be performed according to routine ICU procedures.