Efficacy assessment for NMES in improving muscle strength in patients with SAP complicated by ARDS

Abstract

Objective To evaluates the impact of early application of neuromuscular electrical stimulation (NMES) on muscle strength, clinical outcomes, and long-term quality of life improvements in patients with severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS). Methods A total of 75 patients diagnosed with SAP and ARDS admitted in Department of Critical Care Medicine of our hospital from September 2022 to August 2023 were recruited and then randomly divided into NMES group (n=37) and control group (n=38). After 16 patients were excluded, including 8 died during treatment, 3 discharged and 5 received palliative care, there were finally 29 patients in the NMES group and 30 in the control group. Within 48 h after ICU admission, the NMES group received NMES 1 h per day, for 7 d in addition to standard rehabilitation intervention. While, the control group were given conventional interventions for rehabilitation. Assessments at baseline and post-treatment included the incidence of ICU-acquired weakness (ICU-AW), Medical Research Council (MRC) score, duration of mechanical ventilation, lengths of ICU and total hospital stays, and activity, thickness and thickening fraction of the diaphragm. Mortality rates and Barthel index (BI) for self-care ability in 1, 3 and 6 months after discharge were recorded for follow-up assessments. Results The NMES group had significantly lower incidence of ICU-AW (P < 0.05), higher upper and lower limb MRC scores and overall MRC score at ICU discharge (P < 0.05), shorter durations of mechanical ventilation, ICU stay, and total hospital stay when compared with the control group(P < 0.05). There was no statistical difference in the BI at 1 month post-discharge between the 2 groups, but the indexes at 3 and 6 months were notably higher in the NMES group than the control group (P < 0.05). No obvious differences were observed between the 2 groups in terms of diaphragm activity, thickness, or thickening scores at enrollment, ICU discharge, or hospital discharge, nor in mortality rates at 1, 3, and 6 months after discharge. Conclusion Combined NMES and early rehabilitation therapy can improve muscle strength and reduce length of hospital stay in SAP patients complicated with ARDS, and may enhance long-term quality of life. However, it does not significantly affect diaphragm function or mortality rates.

Keywords

• neuromuscular electrical stimulation
• severe acute pancreatitis
• acute respiratory distress syndrome
• icu-acquired weakness
• muscle strength
• diaphragm