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Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial

Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review

  • 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
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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.

OriginalsprogEngelsk
Artikelnummer53
TidsskriftAnnals of Intensive Care
Vol/bind12
Udgave nummer1
ISSN2110-5820
DOI
StatusUdgivet - dec. 2022

Bibliografisk note

Funding Information:
This study was funded in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001, as well as by the Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS) (contest FAPERGS 05/2019—Programa Pesquisador Gaúcho—PQG). CAPES and FAPERGS had no role in the design or conduct of the study, collection, analysis, or interpretation of data, in the writing of the manuscript or in the decision to submit it for publication. The corresponding authors had full access to all data and the ultimate responsibility for submitting them for publication.

Publisher Copyright:
© 2022, The Author(s).

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