Role of Neuromuscular Electrical Stimulation to Prevent Respiratory Muscle Weakness in Critically Ill Patients and Its Association with Myokine Changes: A Randomized Clinical Trial

What this Trial Is About

This research focuses on critically ill patients in the Intensive Care Unit (ICU) who often experience rapid muscle wasting, especially respiratory muscles, within 18 to 69 hours of mechanical ventilation (MV). This muscle weakness, particularly of the diaphragm, is linked to longer MV use, extended ICU and hospital stays, and higher risk of death. The study explores how early physical activation can prevent these issues but notes that exercise is often limited early on due to sedation and MV. Neuromuscular electrical stimulation (NMES) offers a way to stimulate muscles in patients who cannot actively exercise, potentially preventing muscle wasting and reducing MV duration through effects involving muscle-secreted proteins called myokines. The trial will investigate whether NMES applied to peripheral muscles can also protect the diaphragm and alter myokine levels in ICU patients. The study is a randomized controlled trial involving 32 patients who have been on invasive MV for 24 to 48 hours. Participants will be randomly assigned to receive NMES twice daily for three days or to a control group receiving standard care without NMES. Muscle assessments of the quadriceps and diaphragm will be done at the start (Day 1) and after completing NMES sessions (Day 4 morning). Blood samples will be taken to measure several myokines at multiple times during the first and third days of NMES sessions for the stimulated group, and at two time points for the control group. Standard ICU care, including passive mobilization, will continue unchanged for all patients. Participants will undergo muscle ultrasound and diaphragmatic strength testing using tracheal twitch pressure measurements. Blood serum samples will be collected to analyze myokine changes over time. The study will also record functional outcomes including total time on mechanical ventilation and length of ICU stay at discharge. The main outcomes measured are changes in diaphragmatic strength and thickness fraction from Day 1 to Day 3. This study aims to determine if NMES can prevent respiratory muscle weakness early in critical illness and if this effect is linked to changes in myokine profiles.

NMES Role to Prevent Respiratory Muscle Weakness in Critically Ill Patients and Its Association to Changes in Myokines.