Prolonged immobilization may inevitably lead to complications such as muscle dysfunction and consequently, intensive care unit-acquired weakness (ICUAW) among critically ill COVID-19 patients. This pilot-study examined the effectiveness, feasibility and acceptability of lower-extremity electrical stimulation (E-stim) to prevent these complications.
Methods: COVID-19 patients admitted to ICU due to acute respiratory failure were randomly assigned to control (CG) or intervention (IG) groups. Participants and care providers were blinded to the group allocation. Both groups received daily E-stim (1-hour per session) up to 9-days on both gastrocnemius muscles (GNM). The device was functional in the IG and non-functional in the CG. The primary outcomes included ankle strength (Ankles) and muscle strength (GNMs) measured respectively by an ankle dynamometer and surface-electromyography (sEMG). Muscle endurance (GNMe) in response to E-Stim was also determined by sEMG. Outcomes were assessed at baseline, 3 days, and 9 days.
Results: Thirty-eight (IG=18, CG=20) lower-extremities were independently assessed. There were no significant differences in demographics and clinical characteristics between the groups (p>0.05). The mean time between ICU admission and delivery of E-Stim therapy was 2.2±1.9 days. The IG had higher GNMe at 3 (p=0.04) and 9 (p=0.01) days compared to the CG. While all outcomes were stable in the IG, the CG showed a decline in GNMe (p<0.01) and GNMs (p=0.046) at 3 days compared to baseline.
Conclusions: This study supports proof-of-concept effectiveness of E-stim to prevent muscle dysfunction in critically ill COVID-19 patients. If confirmed in a larger sample, E-Stim may be used as a practical adjunctive therapy to prevent ICUAW among this population.
Source: Zulbaran A, Mishra R, Rodriguez N, et al. Effectiveness of Electrical Stimulation Therapy to Prevent Intensive Care Acquired Weakness in Critically Ill COVID-19 Patients – A Proof of Concept Double-Blinded Randomized Control Trial. Available at https://www.dfcon.com/posters/.
