Effect of electrical muscle stimulation on prevention of ICU acquired muscle weakness and facilitating weaning from mechanical ventilation

Abstract

Objective: ICU acquired muscle weakness (ICUAMW) is an acquired neuromuscular disorder associated with increased duration of mechanical ventilation and weaning suggesting a possible relation between the limb and respiratory neuromuscular involvement. There is no preventive tool and no specific treatment has been proposed for ICU acquired muscle weakness. Aim of this study was to assess the effect of electrical muscle stimulation on prevention of ICUAMW and in facilitating the weaning from mechanical ventilation in critically ill patients.

Design: A prospective, randomized, placebo-controlled trial.

Setting: Critical care department, main Alexandria university hospital.

Patients: 80 Critically ill patients on mechanical ventilation for more than  24 h.

Methods: They were randomly categorized into two groups: 40 patients received conventional lines of treatment only (control group) and 40 patients received in addition one daily session of Electrical Muscle Stimulation (EMS) (EMS group). Assessment of occurrence of ICUAMW was done through the MEDICAL RESEARCH COUNCIL SCALE (MRCS) which is a method for clinical assessment of muscle strength.

Results: MRCS did not show any significant difference between the two groups in the first 3 days post mechanical ventilation while on day 4, MRCS mean value was 46.86± 10.88 in the EMS group versus 43.70 ±9.32 in the control group (p= 0.041). On day 21, MRCS mean value was 29.67± 8.87 in the EMS group versus 19.60 ± 4.34 in the control group (p=0.037). Significant difference was also noted in the duration of mechanical ventilation as the mean value in the EMS group was 9.01 ± 8.01 days versus 11.97 ± 8.07 in the control group (p= 0.048).

Conclusions: Although the EMS could not prevent the occurrence of ICUAMW in critically ill mechanically ventilated patients it still has a role in minimizing the degree of muscular weakness and could be helpful in facilitating weaning from mechanical ventilation.

Keywords: Mechanical ventilation – weaning; Neuro-polyneuropathy