Impacto da intervenção precoce com cicloergometria passiva e estimulação elétrica neuromuscular na espessura muscular de pacientes críticos: ensaio clínico randomizado de três braços, simples-cego e de centro único

Abstract

The hospitalization of critical patients in the Intensive Care Unit (ICU) often results in respiratory and functional complications due to prolonged use of mechanical ventilation, causing loss of muscle strength, hypotrophy and physical deconditioning. This study aimed to evaluate the effectiveness of two treatment protocols: isolated neuromuscular electrostimulation (NMES) and NMES associated with passive cycloergometry (CP), compared to conventional therapy, to minimize muscle mass loss in critical patients in the checking its effects on quadriceps and rectus abdominis muscles. This is a randomized controlled study, conducted in the general ICU of a public hospital in the city of Chapecó-SC. Patients were randomized in the 1:1:1 form, distributed into three groups: GC (conventional physiotherapy), NMES and NMES+CP. Treatment protocols were applied for 7 days. Among 293 eligible patients, 65 were randomized for analysis by intention to treat, of these, 35 participants had therapy discontinued, therefore, 30 patients completed the study and were included in the analysis by protocol. Clinical data were collected from patients and evaluated parameters of thickness of the muscles rectus abdominis, rectus femoral, diaphragm and vast lateral and primary muscle strength. Additionally, the maximum inspiratory pressure and expiratory pressure and peripheral strength were measured through the post-protocol Medical Research score. Of the 30 patients studied, the GC was composed by 10 individuals (n=10), 7 female and 3 male; the NMES (n=11) was composed by 2 female and 9 male and the NMES+CP group (n=9) was composed by 3 female and 6 male. The mean age of participants was 58.67 years (SD 15.02) and the reason for admission was higher prevalence was neurological conditions and acute respiratory failure. The ENEM+CP group showed a significant increase in muscle thickness of the rectus abdominis compared to the CG group. In relation to respiratory muscle strength, the group that received isolated NMES showed greater strength than the GC and NMES+CP groups. The group that received ENEM + CP presented greater oscillation in hemodynamic control than the GC and ENEM alone. In contrast, all groups showed significant improvement in peripheral oxygen saturation. There was no significant difference in mortality rate between the groups. Through the analysis of data we concluded that isolated NMES can offer advantages in muscle mass preservation and hemodynamic stability of critical patients admitted to the ICU.