Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial
Abstract Background Pressure injuries (PIs), especially in the sacral region are frequent, costly, and increase morbidity and mortality of patients in an intensive care unit (ICU). These injuries can occur as a result of prolonged pressure and/or shear forces. Neuromuscular electrical stimulation (N...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-06-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-022-01029-1 |
| _version_ | 1818555404098994176 |
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| author | Miriam Viviane Baron Paulo Eugênio Silva Janine Koepp Janete de Souza Urbanetto Andres Felipe Mantilla Santamaria Michele Paula dos Santos Marcus Vinicius de Mello Pinto Cristine Brandenburg Isabel Cristina Reinheimer Sonia Carvalho Mário Bernardes Wagner Thomas Miliou Carlos Eduardo Poli-de-Figueiredo Bartira Ercília Pinheiro da Costa |
| author_facet | Miriam Viviane Baron Paulo Eugênio Silva Janine Koepp Janete de Souza Urbanetto Andres Felipe Mantilla Santamaria Michele Paula dos Santos Marcus Vinicius de Mello Pinto Cristine Brandenburg Isabel Cristina Reinheimer Sonia Carvalho Mário Bernardes Wagner Thomas Miliou Carlos Eduardo Poli-de-Figueiredo Bartira Ercília Pinheiro da Costa |
| author_sort | Miriam Viviane Baron |
| collection | DOAJ |
| description | Abstract Background Pressure injuries (PIs), especially in the sacral region are frequent, costly, and increase morbidity and mortality of patients in an intensive care unit (ICU). These injuries can occur as a result of prolonged pressure and/or shear forces. Neuromuscular electrical stimulation (NMES) can increase muscle mass and improve local circulation, potentially reducing the incidence of PI. Methods We performed a randomized controlled trial to assess the efficacy and safety of NMES in preventing PI in critically ill patients. We included patients with a period of less than 48 h in the ICU, aged ≥ 18 years. Participants were randomly selected (1:1 ratio) to receive NMES and usual care (NMES group) or only usual care (control group—CG) until discharge, death, or onset of a PI. To assess the effectiveness of NMES, we calculated the relative risk (RR) and number needed to treat (NNT). We assessed the muscle thickness of the gluteus maximus by ultrasonography. To assess safety, we analyzed the effects of NMES on vital signs and checked for the presence of skin burns in the stimulated areas. Clinical outcomes were assessed by time on mechanical ventilation, ICU mortality rate, and length of stay in the ICU. Results We enrolled 149 participants, 76 in the NMES group. PIs were present in 26 (35.6%) patients in the CG and 4 (5.3%) in the NMES group (p ˂ 0.001). The NMES group had an RR = 0.15 (95% CI 0.05–0.40) to develop a PI, NNT = 3.3 (95% CI 2.3–5.9). Moreover, the NMES group presented a shorter length of stay in the ICU: Δ = − 1.8 ± 1.2 days, p = 0.04. There was no significant difference in gluteus maximus thickness between groups (CG: Δ = − 0.37 ± 1.2 cm vs. NMES group: Δ = 0 ± 0.98 cm, p = 0.33). NMES did not promote deleterious changes in vital signs and we did not detect skin burns. Conclusions NMES is an effective and safe therapy for the prevention of PI in critically ill patients and may reduce length of stay in the ICU. Trial registration RBR-8nt9m4. Registered prospectively on July 20th, 2018, https://ensaiosclinicos.gov.br/rg/RBR-8nt9m4 |
| first_indexed | 2024-12-12T09:53:01Z |
| format | Article |
| id | doaj.art-6bd361f89a404f2e98eb2c51ae84716b |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-12T09:53:01Z |
| publishDate | 2022-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-6bd361f89a404f2e98eb2c51ae84716b2022-12-22T00:28:13ZengSpringerOpenAnnals of Intensive Care2110-58202022-06-0112111310.1186/s13613-022-01029-1Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trialMiriam Viviane Baron0Paulo Eugênio Silva1Janine Koepp2Janete de Souza Urbanetto3Andres Felipe Mantilla Santamaria4Michele Paula dos Santos5Marcus Vinicius de Mello Pinto6Cristine Brandenburg7Isabel Cristina Reinheimer8Sonia Carvalho9Mário Bernardes Wagner10Thomas Miliou11Carlos Eduardo Poli-de-Figueiredo12Bartira Ercília Pinheiro da Costa13Pontifical Catholic University of Rio Grande do SulSecretaria de Estado de Saúde do Distrito Federal, Hospital de Base do Distrito FederalUniversity of Santa Cruz do SulPontifical Catholic University of Rio Grande do SulIndustrial University of SantanderPontifical Catholic University of Rio Grande do SulInstituto CelulareFaculdade de Educação, Ciências e Letras do Sertão CentralPontifical Catholic University of Rio Grande do SulRigshospital, Inge LehmannsvejPontifical Catholic University of Rio Grande do SulState University of CampinasPontifical Catholic University of Rio Grande do SulPontifical Catholic University of Rio Grande do SulAbstract Background Pressure injuries (PIs), especially in the sacral region are frequent, costly, and increase morbidity and mortality of patients in an intensive care unit (ICU). These injuries can occur as a result of prolonged pressure and/or shear forces. Neuromuscular electrical stimulation (NMES) can increase muscle mass and improve local circulation, potentially reducing the incidence of PI. Methods We performed a randomized controlled trial to assess the efficacy and safety of NMES in preventing PI in critically ill patients. We included patients with a period of less than 48 h in the ICU, aged ≥ 18 years. Participants were randomly selected (1:1 ratio) to receive NMES and usual care (NMES group) or only usual care (control group—CG) until discharge, death, or onset of a PI. To assess the effectiveness of NMES, we calculated the relative risk (RR) and number needed to treat (NNT). We assessed the muscle thickness of the gluteus maximus by ultrasonography. To assess safety, we analyzed the effects of NMES on vital signs and checked for the presence of skin burns in the stimulated areas. Clinical outcomes were assessed by time on mechanical ventilation, ICU mortality rate, and length of stay in the ICU. Results We enrolled 149 participants, 76 in the NMES group. PIs were present in 26 (35.6%) patients in the CG and 4 (5.3%) in the NMES group (p ˂ 0.001). The NMES group had an RR = 0.15 (95% CI 0.05–0.40) to develop a PI, NNT = 3.3 (95% CI 2.3–5.9). Moreover, the NMES group presented a shorter length of stay in the ICU: Δ = − 1.8 ± 1.2 days, p = 0.04. There was no significant difference in gluteus maximus thickness between groups (CG: Δ = − 0.37 ± 1.2 cm vs. NMES group: Δ = 0 ± 0.98 cm, p = 0.33). NMES did not promote deleterious changes in vital signs and we did not detect skin burns. Conclusions NMES is an effective and safe therapy for the prevention of PI in critically ill patients and may reduce length of stay in the ICU. Trial registration RBR-8nt9m4. Registered prospectively on July 20th, 2018, https://ensaiosclinicos.gov.br/rg/RBR-8nt9m4https://doi.org/10.1186/s13613-022-01029-1Controlled clinical trialDecubitus ulcerElectrical stimulationElectrical stimulation therapyIntensive care unitsNeuromuscular electrical stimulation |
| spellingShingle | Miriam Viviane Baron Paulo Eugênio Silva Janine Koepp Janete de Souza Urbanetto Andres Felipe Mantilla Santamaria Michele Paula dos Santos Marcus Vinicius de Mello Pinto Cristine Brandenburg Isabel Cristina Reinheimer Sonia Carvalho Mário Bernardes Wagner Thomas Miliou Carlos Eduardo Poli-de-Figueiredo Bartira Ercília Pinheiro da Costa Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial Annals of Intensive Care Controlled clinical trial Decubitus ulcer Electrical stimulation Electrical stimulation therapy Intensive care units Neuromuscular electrical stimulation |
| title | Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial |
| title_full | Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial |
| title_fullStr | Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial |
| title_full_unstemmed | Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial |
| title_short | Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial |
| title_sort | efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients a randomized controlled trial |
| topic | Controlled clinical trial Decubitus ulcer Electrical stimulation Electrical stimulation therapy Intensive care units Neuromuscular electrical stimulation |
| url | https://doi.org/10.1186/s13613-022-01029-1 |
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