Chest
Volume 124, Issue 1, July 2003, Pages 292-296
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Clinical Investigations in Critical Care
Peripheral Muscle Strength Training in Bed-Bound Patients With COPD Receiving Mechanical Ventilation: Effect of Electrical Stimulation

https://doi.org/10.1378/chest.124.1.292Get rights and content

Study objective

To compare the effects of active limb mobilization (ALM) with or without electrical stimulation (ES) on muscle strength, respiratory rate (RR), heart rate, oxygen saturation, and time needed to transfer from bed to chair in two groups of patients with COPD.

Design

Randomized, controlled study.

Setting

Respiratory high-dependency care unit.

Patients

Twenty-four bed-bound patients with chronic hypercapnic respiratory failure due to COPD who were receiving mechanical ventilation, with marked peripheral muscle hypotonia and atrophy.

Methods

Patients were randomly assigned either to ALM alone or to ALM plus ES (ALM/ES). ES was applied using square-wave alternate, symmetric, and compensated impulses for 30 min bid. The duration of treatment was 28 days for all patients.

Results

Muscle strength improved significantly in the overall group of patients (from 1.75 ± 0.73 to 3.44 ± 0.65, p < 0.05). Comparing the change (end minus beginning) of the analyzed variables, ALM/ES significantly improved muscle strength (2.16 ± 1.02 vs 1.25 ± 0.75, p = 0.02) and RR (− 1.91 ± 1.72 vs 0.41 ± 1.88, p = 0.004), and decreased the number of days needed to transfer from bed to chair (10.75 ± 2.41 days vs 14.33 ± 2.53 days, p = 0.001).

Conclusion

In bed-bound patients with COPD receiving mechanical ventilation, with marked peripheral muscle hypotonia and atrophy, application of ES in addition to classical ALM significantly improved muscle strength and decreased the number of days needed to transfer from bed to chair.

Section snippets

Patients

The study group was a convenience sample formed of the first 24 subjects who met the inclusion criteria, consented to participate, and completed 28 days of the rehabilitation program. Our entry criteria were chronic hypercapnic respiratory failure due to COPD (the diagnosis of COPD was made according to the Global Initiative for Chronic Obstructive Lung Disease Workshop Report15), need for invasive mechanical ventilation via a tracheostomy, and the presence of a severe peripheral muscle

Results

The patients’ demographic and anthropometric characteristics and blood gas values are shown in Table 2. All patients tolerated both ALM and ALM/ES; nobody refused the procedures. There were no deaths during the study period. Eleven patients were successfully weaned from mechanical ventilation and tracheostomy, 7 patients were weaned from mechanical ventilation but were discharged with a tracheostomy, and 6 patients were discharged still receiving mechanical ventilation.

There were no

Discussion

Exercise training is able to improve muscle strength even in bed-bound patients with COPD and a severe degree of functional impairment who are receiving mechanical ventilation. The addition of ES may further enhance the effects of classical rehabilitation treatment.

People with COPD are often confined to their house, isolated, and depressed as they try to avoid dyspnea. These features lead to significant debilitation, which further worsens dyspnea. Casaburi1 pointed out that the list of

ACKNOWLEDGMENT

The authors thank Dr. Rachel Stenner for review of the manuscript.

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