Author: Lee, Chun Kit
Title: Preserving the limbs muscle bulk for patients with critical illness on mechanical ventilation in ICU
Advisors: Ng, Gabriel (RS)
Degree: DHSc
Year: 2018
Subject: Hong Kong Polytechnic University -- Dissertations
Electric stimulation
Critical care medicine
Department: Faculty of Health and Social Sciences
Pages: xi, 134 pages : color illustrations
Language: English
Abstract: Objective: The present study aimed to examine the effect of early neuromuscular electrical stimulation (NMES) treatment in patients admitted to an intensive care unit (ICU) who are on mechanical ventilation. There were three outcome measures, namely, (1) the quadriceps and biceps muscle size in terms of cross-sectional thickness (CSD) and area (CSA), (2) the quality of life and functional status of those patients receiving NMES at discharge from ICU, and (3) the length of stay in ICU and in hospital, and also the number of patients diagnosed with ICU acquired weakness at discharge from ICU. Methods: Forty-nine patients under mechanical ventilation in an ICU were recruited within 48 hours after ICU admission. Informed consent was obtained if patients were awake. For those who were sedated or in a state of coma, consents were obtained from their legal guardian/legally authorized representatives. Once the patients regained consciousness, they would be asked to provide consent before the study continued. Patients were randomly assigned with one limb for NMES treatment and the other limb acted as control without intervention. The NMES treatment was applied to the quadriceps and biceps muscles for 30 minutes per day over 5 consecutive days. The CSD and CSA of quadriceps femoris and biceps brachii muscles were measured by using high-resolution real-time ultrasonography on Day 1 and 5 of intervention and one week after the end of treatment. Demographical data and APACHE II score were collected on ICU admission. Also, ICU length of stay and hospital length of stay were collected for this study. Results: On Day 5, thickness of the quadriceps and biceps muscles was 14.07% (P=0.04) and 15.01% (p=0.047) greater on the treated limbs than the control limbs. The cross-sectional area of quadriceps was 8.65% (p=0.014) larger whereas the biceps was 9.63% (p=0.011) larger on the treated limbs than the control limbs. On Day 12, the mean CSD and CSA of quadriceps and biceps muscle were still larger in the NMES treated limbs than the control limbs. However, the result was not statistically significant (p=0.051-0.151). For the functional assessment, the Functional Status Score for the Intensive Care Unit (FSS-ICU) scores were significantly lower (p<0.01) at discharge from ICU with a median (interquartile range) of 35 versus 24 (11.5-27). The mean (SD) of Physical Component Summary (PCS) and Mental Component Summary (MCS) of SF-36 were 35.45 ± 6.72 and 35.34 ± 4.11, respectively. Conclusion: Early application of NMES for patients on mechanical ventilation in ICU could effectively delay muscle atrophy and minimize the development of ICU acquired weakness.
Rights: All rights reserved
Access: restricted access

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