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Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial [with consumer summary]
Routsi C, Gerovasili V, Vasileiadis I, Karatzanos E, Pitsolis T, Tripodaki E, Markaki V, Zervakis D, Nanas S
Critical Care 2010 Apr 28;14(2):R74
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

INTRODUCTION: Critical illness polyneuromyopathy (CIPNM) is a common complication of critical illness presenting with muscle weakness and is associated with increased duration of mechanical ventilation and weaning period. No preventive tool and no specific treatment have been proposed so far for CIPNM. Electrical muscle stimulation (EMS) has been shown to be beneficial in patients with severe chronic heart failure and chronic obstructive pulmonary disease. Aim of our study was to assess the efficacy of EMS in preventing CIPNM in critically ill patients. METHODS: One hundred and forty consecutive critically ill patients with an APACHE II score >= 13 were randomly assigned after stratification to the EMS group (n = 68) (age 61 +/- 19 years) (APACHE II 18 +/- 4, SOFA 9 +/- 3) or to the control group (n = 72) (age 58 +/- 18 years) (APACHE II 18 +/- 5, SOFA 9 +/- 3). Patients of the EMS group received daily EMS sessions. CIPNM was diagnosed clinically with the medical research council (MRC) scale for muscle strength (maximum score 60, < 48/60 cut off for diagnosis) by two unblinded independent investigators. Duration of weaning from mechanical ventilation and intensive care unit (ICU) stay were recorded. RESULTS: Fifty two patients could be finally evaluated with MRC; 24 in the EMS group and 28 in the control group. CIPNM was diagnosed in 3 patients in the EMS group as compared to 11 patients in the control group (OR 0.22; CI 0.05 to 0.92, p = 0.04). The MRC score was significantly higher in patients of the EMS group as compared to the control group (58 (33 to 60) versus 52 (2 to 60) respectively, median (range), p = 0.04). The weaning period was statistically significantly shorter in patients of the EMS group versus the control group (1 (0 to 10) days versus 3 (0 to 44) days, respectively, median (range), p = 0.003). CONCLUSIONS: This study suggests that daily EMS sessions prevent the development of CIPNM in critically ill patients and also result in shorter duration of weaning. Further studies should evaluate which patients benefit more from EMS and explore the EMS characteristics most appropriate for preventing CIPNM. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT00882830.

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