101
|
Magalhães P, Figueirêdo BB, Vasconcelos A, de Andrade ÉM, Dornelas de Andrade A, Reinaux C. Is transcutaneous electrical muscle stimulation an alternative for preventing acquired muscle weakness in the pediatric intensive care unit? A scoping review. Pediatr Pulmonol 2019; 54:1108-1116. [PMID: 31134767 DOI: 10.1002/ppul.24293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Transcutaneous electrical muscle stimulation (TEMS) has been progressively used as add-on therapy to reduce muscle atrophy in adults unable to carry out active mobilization in the intensive care unit (ICU). There are no studies addressing TEMS in the pediatric ICU. Therefore, we decided to develop a scoping review, a type of knowledge synthesis, which unlike systematic review, identify gaps in the literature to aid the planning and commissioning of future research. OBJECTIVE To provide current perspectives on the application of TEMS for combating pediatric intensive care unit acquired weakness (PICUAW). METHODS Online databases were used to identify papers published 2006-2016, from which we selected those used musculoskeletal and cardiorespiratory performance as a primary or secondary outcome variable in participants under 18 years. RESULTS The publications reported six clinical trials from 218 outpatients with 9.5 ± 8 years old. There were differences in current modulation and duration of TEMS sessions, with a predominance of high intensity and short duration in which a muscle contraction is triggered. The main use of TEMS was in pediatric neurological disorders. TEMS was more effective when compared with SHAM on spasticity, bone mineral density, disability, and gait. One study regarding spine injury showed improvement in VO2 (P = 0.035) when combined cycling with TEMS. CONCLUSION TEMS was an effective and safe treatment for musculoskeletal impairments and cardiorespiratory performance in children with neurological disorders. Although the physiopathology is different in outpatients, an individualized protocol with TEMS might be promising for preventing PICUAW. Its effectiveness, however, deserves further investigation.
Collapse
Affiliation(s)
- Paulo Magalhães
- Department of Physical Therapy, Pernambuco University, Petrolina, Pernambuco, Brazil.,Department of Physical Therapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Alanna Vasconcelos
- Department of Physical Therapy, Pernambuco University, Petrolina, Pernambuco, Brazil
| | | | | | - Cyda Reinaux
- Department of Physical Therapy, Pernambuco University, Petrolina, Pernambuco, Brazil
| |
Collapse
|
102
|
Piva S, Fagoni N, Latronico N. Intensive care unit-acquired weakness: unanswered questions and targets for future research. F1000Res 2019; 8. [PMID: 31069055 PMCID: PMC6480958 DOI: 10.12688/f1000research.17376.1] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 12/23/2022] Open
Abstract
Intensive care unit-acquired weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients. We discuss critical aspects of ICU-AW that have not been completely defined or that are still under discussion. Critical illness polyneuropathy, myopathy, and muscle atrophy contribute in various proportions to ICU-AW. Diagnosis of ICU-AW is clinical and is based on Medical Research Council sum score and handgrip dynamometry for limb weakness and recognition of a patient's ventilator dependency or difficult weaning from artificial ventilation for diaphragmatic weakness (DW). ICU-AW can be caused by a critical illness polyneuropathy, a critical illness myopathy, or muscle disuse atrophy, alone or in combination. Its diagnosis requires both clinical assessment of muscle strength and complete electrophysiological evaluation of peripheral nerves and muscles. The peroneal nerve test (PENT) is a quick simplified electrophysiological test with high sensitivity and good specificity that can be used instead of complete electrophysiological evaluation as a screening test in non-cooperative patients. DW, assessed by bilateral phrenic nerve magnetic stimulation or diaphragm ultrasound, can be an isolated event without concurrent limb muscle involvement. Therefore, it remains uncertain whether DW and limb weakness are different manifestations of the same syndrome or are two distinct entities. Delirium is often associated with ICU-AW but a clear correlation between these two entities requires further studies. Artificial nutrition may have an impact on ICU-AW, but no study has assessed the impact of nutrition on ICU-AW as the primary outcome. Early mobilization improves activity limitation at hospital discharge if it is started early in the ICU, but beneficial long-term effects are not established. Determinants of ICU-AW can be many and can interact with each other. Therefore, future studies assessing early mobilization should consider a holistic patient approach with consideration of all components that may lead to muscle weakness.
Collapse
Affiliation(s)
- Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy, 25123, Italy.,Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Brescia, Italy, 25123, Italy
| | - Nazzareno Fagoni
- Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Brescia, Italy, 25123, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy, 25123, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy, 25123, Italy.,Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Brescia, Italy, 25123, Italy
| |
Collapse
|
103
|
A unifying hypothesis for delirium and hospital-acquired weakness as synaptic dysfunctions. Med Hypotheses 2019; 124:105-109. [DOI: 10.1016/j.mehy.2019.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/20/2018] [Accepted: 02/03/2019] [Indexed: 12/23/2022]
|
104
|
Schefold JC, Messmer AS, Wenger S, Müller L, von Haehling S, Doehner W, McPhee JS, Fux M, Rösler KM, Scheidegger O, Olariu R, Z’Graggen W, Rezzi S, Grathwohl D, Konz T, Takala J, Cuenoud B, Jakob SM. Nutrient pattern analysis in critically ill patients using Omics technology (NAChO) - Study protocol for a prospective observational study. Medicine (Baltimore) 2019; 98:e13937. [PMID: 30608424 PMCID: PMC6344160 DOI: 10.1097/md.0000000000013937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Intensive care unit-acquired weakness (ICU-AW) is often observed in critically ill patients with prolonged intensive care unit (ICU) stay. We hypothesized that evolving metabolic abnormalities during prolonged ICU stay are reflected by changing nutrient patterns in blood, urine and skeletal muscle, and that these patterns differ in patients with/without ICU-AW and between patients with/without sepsis. METHODS In a prospective single-center observational trial, we aim to recruit 100 critically ill patients (ICU length of stay ≥ 5 days) with severe sepsis/septic shock ("sepsis group", n = 50) or severe head trauma/intracerebral hemorrhage ("CNS group", n = 50). Patients will be sub-grouped for presence or absence of ICU-AW as determined by the Medical Research Council sum score. Blood and urine samples will be collected and subjected to comprehensive nutrient analysis at different time points by targeted quantitative mass spectrometric methods. In addition, changes in muscular tissue (biopsy, when available), muscular architecture (ultrasound), electrophysiology, body composition analyses (bioimpedance, cerebral magnetic resonance imaging), along with clinical status will be assessed. Patients will be followed-up for 180 and 360 days including assessment of quality of life. DISCUSSION Key objective of this trial is to assess changes in nutrient pattern in blood and urine over time in critically ill patients with/without ICU-AW by using quantitative nutrient analysis techniques. Peer-reviewed published NAChO data will allow for a better understanding of metabolic changes in critically ill patients on standard liquid enteral nutrition and will likely open up new avenues for future therapeutic and nutritional interventions.
Collapse
Affiliation(s)
- Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Anna S. Messmer
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Stefanie Wenger
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lionel Müller
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Stephan von Haehling
- Metabolic Research Unit, Department Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
| | - Wolfram Doehner
- Neuro Research Center, Charite University Medicine Berlin, Berlin, Germany
| | - Jamie S. McPhee
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
| | - Michaela Fux
- Clinical Cytomics Facility, University Institute of Clinical Chemistry and Centre of Laboratory Medicine
| | | | | | | | - Werner Z’Graggen
- Depts. of Neurosurgery and Neurology, Inselspital, Bern University Hospital, University of Bern
| | - Serge Rezzi
- Nestlé Research, vers-chez-les-Blanc, Lausanne
- Swiss Vitamin Institute, Epalinges, Switzerland
| | | | - Tobias Konz
- Nestlé Research, vers-chez-les-Blanc, Lausanne
| | - Jukka Takala
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Stephan M. Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| |
Collapse
|
105
|
Parotto M, Batt J, Herridge M. The Pathophysiology of Neuromuscular Dysfunction in Critical Illness. Crit Care Clin 2018; 34:549-556. [PMID: 30223993 DOI: 10.1016/j.ccc.2018.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Disability after critical illness is heterogeneous and related to multiple morbidities. Muscle and nerve injury represent prevalent and important determinants of long-term disability. As the population ages and accrues a greater burden of comorbid illness and medical complexity, those patients admitted to an intensive care unit will be challenged in their recovery because of diminished organ reserve and variable tissue resiliency. This represents a significant burgeoning public health concern. This article presents a brief overview of the pathophysiology and the emerging basic science of neuromuscular dysfunction in critical illness.
Collapse
Affiliation(s)
- Matteo Parotto
- Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, ON M5G 1E2, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, EN 442 - 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, 209 Victoria Street, Toronto, ON M5B 1T8, Canada.
| | - Jane Batt
- Department of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON M5S 1A8, Canada; Keenan Research Centre for Biomedical Research, 30 Bond St, Toronto, ON M5B 1W8, Canada
| | - Margaret Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, 209 Victoria Street, Toronto, ON M5B 1T8, Canada; Department of Medicine, University Health Network, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| |
Collapse
|