Article

As the population ages and critical care advances, a growing number
of survivors of critical illness will be at risk for intensive care unit
(ICU)-acquired weakness. Bed rest, which is common in the ICU, causes adverse
effects, including muscle weakness. Consequently, patients need ICU-based
interventions focused on the muscular system. Although emerging evidence supports
the benefits of early rehabilitation during mechanical ventilation, additional
therapies may be beneficial. Neuromuscular electrical stimulation (NMES), which
can provide some muscular activity even very early during critical illness, is a
promising modality for patients in the ICU. OBJECTIVE: The objectives of this
article are to discuss the implications of bed rest for patients with critical
illness, summarize recent studies of early rehabilitation and NMES in the ICU,
and describe a protocol for a randomized, phase II pilot study of NMES in
patients receiving mechanical ventilation. DESIGN: The study was a randomized,
sham-controlled, concealed, phase II pilot study with caregivers and outcome
assessors blinded to the treatment allocation. SETTING: The study setting will be
a medical ICU. PARTICIPANTS: The study participants will be patients who are
receiving mechanical ventilation for 1 day or more, who are expected to stay in
the ICU for an additional 2 days or more, and who meet no exclusion criteria.
INTERVENTION: The intervention will be NMES (versus a sham [control]
intervention) applied to the quadriceps, tibialis anterior, and gastrocnemius
muscles for 60 minutes per day. MEASUREMENTS: Lower-extremity muscle strength at
hospital discharge will be the primary outcome measure. LIMITATIONS: Muscle
strength is a surrogate measure, not a patient-centered outcome. The assessments
will not include laboratory, genetic, or histological measures aimed at a
mechanistic understanding of NMES. The optimal duration or dose of NMES is
unclear. CONCLUSIONS: If NMES is beneficial, the results of the study will help
advance research aimed at reducing the burden of muscular weakness and physical
disability in survivors of critical illness.

Langue : ANGLAIS