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Randomized Controlled Trial
. 2023 Mar-Apr:58:229-235.
doi: 10.1016/j.hrtlng.2022.11.013. Epub 2022 Dec 5.

Combining exercise, protein supplementation and electric stimulation to mitigate muscle wasting and improve outcomes for survivors of critical illness-The ExPrES study

Avelino C Verceles  1 , Monica Serra  2 , Derik Davis  3 , Gad Alon  4 , Chris L Wells  5 , Elizabeth Parker  4 , John Sorkin  6 , Waqas Bhatti  7 , Michael L Terrin  7
Affiliations
Randomized Controlled Trial

Combining exercise, protein supplementation and electric stimulation to mitigate muscle wasting and improve outcomes for survivors of critical illness-The ExPrES study

Avelino C Verceles et al. Heart Lung. 2023 Mar-Apr.

Abstract

Background: Neuromuscular electrical stimulation (NMES) with high protein supplementation (HPRO) to preserve muscle mass and function has not been assessed in ICU patients. We compared the effects of combining NMES and HPRO with mobility and strength rehabilitation (NMES+HPRO+PT) to standardized ICU care.

Objectives: To assess the effectiveness of combined NMES+HPRO+PT in mitigating sarcopenia as evidenced by CT volume and cross-sectional area when compared to usual ICU care. Additionally, we assessed the effects of the combined therapy on select clinical outcomes, including nutritional status, nitrogen balance, delirium and days on mechanical ventilation.

Methods: Participants were randomized by computer generated assignments to receive either NMES+HPRO+PT or standard care. Over 14 days the standardized ICU care group (N = 23) received usual critical care and rehabilitation while the NMES+HPRO+PT group (N = 16) received 30 min neuromuscular electrical stimulation of quadriceps and dorsiflexors twice-daily for 10 days and mean 1.3 ± 0.4 g/kg body weight of high protein supplementation in addition to standard care. Nonresponsive participants received passive exercises and, once responsive, were encouraged to exercise actively. Primary outcome measures were muscle volume and cross-sectional area measured using CT-imaging. Secondary outcomes included nutritional status, nitrogen balance, delirium and days on mechanical ventilation.

Results: The NMES+HPRO+PT group (N = 16) lost less lower extremity muscle volume compared to the standard care group (N = 23) and had larger mean combined thigh cross-sectional area. The nitrogen balance remained negative in the standard care group, while positive on days 5, 9, and 14 in the NMES+HPRO+PT group. Standard care group participants experienced more delirium than the NMES+HPRO+PT group. No differences between groups when comparing length of stay or mechanical ventilation days.

Conclusions: The combination of neuromuscular electrical stimulation, high protein supplementation and mobility and strength rehabilitation resulted in mitigation of lower extremity muscle loss and less delirium in mechanically ventilated ICU patients.

Trial registration: Clinicaltrials.gov identifier: NCT02509520. Registered July 28, 2015.

Keywords: Critical care nutrition; High protein supplement; ICU; ICU acquired weakness; Multimodal rehabilitation training; Neuromuscular electrical stimulation.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Avelino Verceles reports financial support was provided by National Institute on Aging. Monica Serra reports financial support was provided by US Department of Veterans Affairs.

Figures

FIGURE 1.
FIGURE 1.
CONSORT DIAGRAM
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Comment in

References

    1. Puthucheary ZA, McPhail MJ, Hart N. Acute muscle wasting among critically ill patients--reply. JAMA 2014; 311[6]:622–623. - PubMed
    1. Klaude M, Mori M, Tjader I, Gustafsson T, Wernerman J, Rooyackers O. Protein metabolism and gene expression in skeletal muscle of critically ill patients with sepsis. Clin Sci [Lond] 2012; 122[3]:133–142. - PubMed
    1. Paddon-Jones D, Sheffield-Moore M, Cree MG, Hewlings SJ, Aarsland A, Wolfe RR, et al. Atrophy and impaired muscle protein synthesis during prolonged inactivity and stress. J Clin Endocrinol Metab 2006; 91[12]:4836–4841. - PubMed
    1. Essen P, McNurlan MA, Gamrin L, Hunter K, Calder G, Garlick PJ, et al. Tissue protein synthesis rates in critically ill patients. Crit Care Med 1998; 26[1]:92–100. - PubMed
    1. Helliwell TR, Coakley JH, Wagenmakers AJ, Griffiths RD, Campbell IT, Green CJ, et al. Necrotizing myopathy in critically-ill patients. J Pathol 1991; 164[4]:307–314. - PubMed

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