Chest
Volume 136, Issue 5, November 2009, Pages 1249-1256
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Original Research
Critical Care Medicine
Short-term Systemic Effect of Electrical Muscle Stimulation in Critically Ill Patients

https://doi.org/10.1378/chest.08-2888Get rights and content

Background

Our study assessed the short-term effect of electrical muscle stimulation (EMS) of the lower extremities on the thenar muscle microcirculation of patients who are critically ill.

Methods

Twenty-nine hospital ICU patients (19 men; mean [± SD] age, 58 ± 19 years; mean acute physiology and chronic health evaluation score, 17 ± 5; mean sequential organ failure assessment score, 9 ± 3) underwent a 45-min session of EMS of the lower extremities. BP and heart rate were measured, and blood samples were retrieved. Tissue oxygen saturation (Sto2) was assessed with near infrared spectroscopy at the thenar muscle with a vascular occlusion before and after EMS. A control group of six patients who were critically ill (4 men; mean age, 50 ± 19 years) also were included in the study.

Results

The mean Sto2 did not differ significantly before and after the EMS session (81 ± 16% vs 83 ± 16%, respectively). The oxygen consumption rate during vascular occlusion differed significantly before the beginning and at the end of the session (20 ± 9%/min vs 22 ± 9%/min, respectively; p < 0.05). The reperfusion rate differed significantly before the beginning and at the end of the session (299 ± 177%/min vs 375 ± 182%/min, respectively; p < 0.05). Heart rate increased significantly at the end of the session (94 ± 16 beats/min vs 99 ± 16 beats/min, respectively; p < 0.05) as did systolic BP (127 ± 21 mm Hg vs 133 ± 23 mm Hg; p < 0.05, respectively). The Sto2 value did not differ between the two measurements in control patients.

Conclusion

The data suggest that EMS has a systemic effect on microcirculation. These results suggest that further studies are needed to explore the potential use of EMS as a preventive and rehabilitation tool in critically ill patients.

Section snippets

Patients

The study was approved by the Scientific Council and the Ethics Committee of our hospital. Thirty-one patients who were critically ill (20 men; mean [± SD] age, 58 ± 19 years) admitted to our multidisciplinary hospital ICU were prospectively included in the study. Exclusion criteria were age < 18 years; pregnancy; obesity (body mass index > 35 kg/m2); brain death; preexisting neuromuscular disease; diseases with systemic vascular involvement, such as lupus erythematosus; and technical obstacles

General Clinical and Laboratory Evaluation

The general clinical and laboratory evaluations are shown in Table 2. After the EMS session, there was a statistically significant, but clinically insignificant increase in mean heart rate and (94 ± 16 beats/min vs 99 ± 16 beats/min, respectively; p < 0.05) and systolic BP (127 ± 21 mm Hg vs 133 ± 23 mm Hg, respectively; p < 0.05) [Table 2]. Arterial blood gas levels and central venous oxygen saturation did not differ significantly at the end of the session (Table 2). The respiratory rate

Discussion

This study evaluated the short-term effect of a single, 45-min EMS session on the microcirculation of patients who were critically ill. The main finding is that EMS of the lower extremities induces a short-term systemic effect on the microcirculation of the thenar muscle. To our knowledge, this study is the first to use EMS in hospital ICU patients in order to assess its systemic effect on the microcirculation with the use of NIRS and the vascular occlusion technique.

EMS has been used as an

Conclusions

EMS is well tolerated and seems to have a short-term systemic effect on the peripheral microcirculation of patients who are critically ill, as assessed by NIRS using the vascular occlusion technique. The factors responsible for this systemic effect, such as the role of cytokines, should be explored in future studies. The fact that EMS has a systemic effect enhances the plausibility of evaluating the role of EMS as a preventive and therapeutic tool in patients who are critically ill with CIPNM.

Acknowledgments

Author contributions: All authors have contributed substantially to the submitted work and have read and approved the final manuscript. In particular, Dr. Gerovasili participated in the design of the study, data acquisition, analysis, and drafting of the manuscript. Drs. Tripodaki and Pitsolis, and Mr. Karatzanos participated in data acquisition, analysis, and drafting of the manuscript. Drs. Markaki and Zervakis revised critically the manuscript. Dr. Routsi helped with data analysis, revised

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Funding/Support: This research project (PENED) was cofinanced by the EU-European Social Fund and the Greek Ministry of Development (GSRT).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

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