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

中文翻译：

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神经肌肉电刺激预防危重患者压力性损伤的疗效和安全性：一项随机对照试验

背景

压力性损伤 (PI)，尤其是在骶骨区域，是常见的、昂贵的，并且会增加重症监护病房 (ICU) 患者的发病率和死亡率。这些伤害可能是由于长时间的压力和/或剪切力而发生的。神经肌肉电刺激 (NMES) 可以增加肌肉质量并改善局部循环，从而可能降低 PI 的发生率。

方法

我们进行了一项随机对照试验，以评估 NMES 在预防重症患者 PI 方面的有效性和安全性。我们纳入了在 ICU 停留时间少于 48 小时、年龄≥18 岁的患者。参与者被随机选择（1:1 比例）接受 NMES 和常规护理（NMES 组）或仅常规护理（对照组 - CG），直至出院、死亡或 PI 发作。为了评估 NMES 的有效性，我们计算了相对风险 (RR) 和需要治疗的人数 (NNT)。我们通过超声检查评估了臀大肌的肌肉厚度。为了评估安全性，我们分析了 NMES 对生命体征的影响，并检查了受刺激区域是否存在皮肤烧伤。通过机械通气时间、ICU死亡率和ICU住院时间评估临床结果。

结果

我们招募了 149 名参与者，其中 76 名在 NMES 组中。CG 组 26 例（35.6%）患者和 NMES 组 4 例（5.3%）患者存在 PI（p˂  0.001）。NMES 组的 RR = 0.15 (95% CI 0.05–0.40) 以开发 PI，NNT = 3.3 (95% CI 2.3–5.9)。此外，NMES 组在 ICU 的停留时间更短：Δ = - 1.8 ± 1.2 天，p = 0.04。组间臀大肌厚度没有显着差异（CG：Δ = - 0.37 ± 1.2 cm 与 NMES 组：Δ = 0 ± 0.98 cm，p  = 0.33）。NMES 没有促进生命体征的有害变化，我们也没有检测到皮肤烧伤。

结论

NMES 是预防重症患者 PI 的一种有效且安全的疗法，可缩短 ICU 住院时间。

试用注册RBR-8nt9m4。2018 年 7 月 20 日前瞻性注册，https://ensaiosclinicos.gov.br/rg/RBR-8nt9m4