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Efficacy of electrical muscle stimulation on preserving the muscle mass of critically ill patients


Critically ill patients are characterized by increased loss of muscle mass, partially attributed to sepsis and multiple organ failure, as well as immobilization. Recent studies have shown that electrical muscle stimulation (EMS) may be an alternative to active exercise in chronic obstructive pulmonary disease and chronic heart failure patients with myopathy. The role of EMS for the preservation of muscle mass of critically ill patients has not been studied. The aim of our study was to investigate the EMS effects on muscle mass preservation of critically ill patients with the use of ultrasonography (US).


Ten consecutive critically ill patients (age: 69 ± 16 years, APACHE score: 22 ± 5, SOFA score: 10 ± 3) were randomly assigned upon admission to receive daily EMS sessions (45-min session, 5 days per week) of the vastus lateralis, vastus medialis and peroneus longus muscles of both lower extremities (EMS group) or to the control group (non-EMS group). Muscle mass was evaluated with US, by measuring the cross-sectional diameter (CSD) of the quadriceps muscle (rectus femoris–vastus intermedius). US images were obtained using a GE Vivid 7 model ultrasound scanner with a 7.5 MHz linear probe. The position of the probe was selected as midway between the anterior superior iliac spine and the midpoint of the patella, and was placed ventral to the transverse plane and perpendicular to the skin. To standardize the measurements of the US, the position that was selected was marked for the following measurement. The measurements were performed on the second and seventh day following admission.


The rectus femorist CSD decreased in both groups (EMS group: from 1.24 ± 0.33 to 1.16 ± 0.35 cm, non-EMS group: from 1.52 ± 0.51 to 1.25 ± 0.43 cm) (P < 0.05); however, the EMS group (-0.08 ± 0.05 cm, -7.2 ± 4.1%) was observed to decrease significantly less (P < 0.05) than the non-EMS group (-0.26 ± 0.13 cm, -17.3 ± 7.6%). The vastus intermedius CSD decreased in both groups (EMS group: from 0.87 ± 0.43 to 0.79 ± 0.42 cm, non-EMS group: from 1.65 ± 0.65 to 1.23 ± 0.47 cm) (P < 0.05), and there was a significant difference (P < 0.05) between the EMS group (-0.08 ± 0.02 cm, -10.0 ± 5.0%) and the non-EMS group (-0.41 ± 0.21 cm, -24.6 ± 5.1%).


The preliminary data presented suggest that EMS may preserve the muscle mass of critically ill patients. These results as well as the potential use of EMS as a preventive and rehabilitation tool in ICU patients with polyneuromyopathy need to be further investigated.

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Gerovasili, V., Stefanidis, K., Vitzilaios, K. et al. Efficacy of electrical muscle stimulation on preserving the muscle mass of critically ill patients. Crit Care 12 (Suppl 2), P516 (2008).

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