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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

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  • 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.

Original languageEnglish
Article number53
JournalAnnals of Intensive Care
Volume12
Issue number1
ISSN2110-5820
DOIs
Publication statusPublished - Dec 2022

Bibliographical note

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

    Research areas

  • Controlled clinical trial, Decubitus ulcer, Electrical stimulation, Electrical stimulation therapy, Intensive care units, Neuromuscular electrical stimulation, Pressure ulcer, Preventive therapy

ID: 79411555