Journal Article

Effects of physical therapy with neuromuscular electrical stimulation in acute and late septic shock patients: A randomised crossover clinical trial

Basile-Filho, Anibal, Lago, Alessandra Fabiane, de Souza, Hugo Celso Dutra, de Oliveira, Anamaria Siriani, Gastaldi, Ada Clarice, dos Santos, Daniele Oliveira

2022

Overview

Patients with sepsis and immobility in the intensive care unit are associated with muscle weakness, and early mobilisation can counteract it. However, during septic shock, mobilisation is often delayed due to the severity of the illness. Neuromuscular electrical stimulation (NMES) may be an alternative to mobilise these patients early. This study aims to identify whether NMES performed within the first 72 hours of septic shock diagnosis or later is safe from a metabolic perspective. This is the analysis of two randomised controlled crossover studies. Patients with acute septic shock (within the first 72 hours of diagnosis) and sepsis and septic shock in the late phase (after 72 hours of diagnosis) were eligible. Patients were submitted in a random order to the intervention protocol (dorsal decubitus position with the lower limbs raised and NMES) and control (dorsal decubitus position with the lower limbs raised without NMES). The patients were allocated in group 1 (intervention and control) or group 2 (control and intervention) with a wash-out period of 4 to 6 hours. Metabolic variables were evaluated by indirect calorimetry. Sixteen patients were analysed in the acute septic shock study and 21 in the late sepsis/septic shock study. There were no significant differences between Oxygen Consumption (VO2) values in the acute phase of septic shock when the baseline period, intervention, and control protocols were compared (186.59 ± 46.10; 183.64 ± 41.39; 188.97 ± 44.88, p>0.05- expressed in mL/Kg/min). The same was observed when the VO2 values in the late phase were compared (224.22 ± 53.09; 226.20 ± 49.64; 226.79 ± 58.25, p>0.05). The other metabolic variables followed the same pattern, with no significant differences between the protocols. When metabolic variables were compared between acute to late phase, significant differences were observed (p<0.05). As metabolic rates in septic shock patients had no increase during NMES, either in the first 72 hours of diagnosis or later, NMES can be considered safe from a metabolic viewpoint, even despite the higher metabolic demand in the acute phase of shock. NCT03193164; NCT03815994. Registered on June 5, 2017; November 13, 2018 (clinicaltrials.gov/).

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Biology and Life Sciences / Blood pressure / Calorimetry / Cardiac arrhythmia / Care and treatment / Case-Control Studies / Complications and side effects / Consent / Contraindications / Cross-Over Studies / Diagnosis / Electric Stimulation Therapy - methods / Electrical stimuli / Exercise Therapy - methods / Female / Health sciences / Heart rate / Humans / Intensive care / Intervention / Ischemia / Limbs / Lower Extremity - blood supply / Male / Medical schools / Medicine and Health Sciences / Metabolic rate / Metabolism / Middle Aged / Muscle strength / Muscle Weakness - etiology / Muscle Weakness - metabolism / Muscle Weakness - pathology / Muscle Weakness - therapy / Muscles / Neuromuscular electrical stimulation / Oxygen / Oxygen Consumption / Pain / Patient outcomes / Patients / Physical therapy / Sepsis / Septic shock / Shock, Septic - complications / Stimulation / Therapeutics, Physiological / Vanadium oxides / Ventilators