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Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock*

Poulsen, Jesper B. MD; Møller, Kirsten MD, PhD; Jensen, Claus V. MD; Weisdorf, Sigge MD; Kehlet, Henrik MD, PhD; Perner, Anders MD, PhD

doi: 10.1097/CCM.0b013e318205c7bc
Clinical Investigations

Objective: Intensive care unit admission is associated with muscle wasting and impaired physical function. We investigated the effect of early transcutaneous electrical muscle stimulation on quadriceps muscle volume in patients with septic shock.

Design: Randomized interventional study using a single-legged exercise design with the contralateral leg serving as a paired control.

Setting: A mixed 18-bed intensive care unit at a tertiary care university hospital.

Patients: Eight adult male intensive care unit patients with septic shock included within 72 hrs of diagnosis.

Interventions: After randomization of the quadriceps muscles, transcutaneous electrical muscle stimulation was applied on the intervention side for 7 consecutive days and for 60 mins per day. All patients underwent computed tomographic scans of both thighs immediately before and after the 7-day treatment period. The quadriceps muscle was manually delineated on the computed tomography slices, and muscle volumes were calculated after three-dimensional reconstruction.

Measurements and Main Results: Median age and Acute Physiology and Chronic Health Evaluation II score were 67 years (interquartile range, 64–72 years) and 25 (interquartile range, 20–29), respectively. During the 7-day study period, the volume of the quadriceps muscle on the control thigh decreased by 16% (4–21%, p = .03) corresponding to a rate of 2.3% per day. The volume of the stimulated muscle decreased by 20% (3–25%, p = .04) corresponding to a rate of 2.9% per day (p = .12 for the difference in decrease). There was no difference in muscle volume between the stimulated and nonstimulated thigh at baseline (p = .10) or at day 7 (p = .12). The charge delivered to the muscle tissue per training session (0.82 [0.66–1.18] coulomb) correlated with the maximum sequential organ failure assessment score.

Conclusions: We observed a marked decrease in quadriceps volume within the first week of intensive care for septic shock. This loss of muscle mass was unaffected by transcutaneous electrical muscle stimulation applied for 60 mins per day for 7 days.

From the Department of Intensive Care (JBP, KM, AP), the Section for Surgical Pathophysiology (HK), and the Department of Diagnostic Radiology (CVJ), Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; and the Laboratory of Biological Anthropology (SW), Institute of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark.

Supported by grants from The Copenhagen Hospital Corporation, The Foundation of Jacob Ehrenreich and wife Grete Ehrenreich, and The A.P. Møller Foundation for the Advancement of Medical Science.

Preliminary results of this study have been presented at the ESICM meeting in Vienna Oct. 2009.

Dr. Weisdorf has not disclosed any potential conflicts of interest. The remaining authors received funding from the Local Research Council.

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© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins