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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2022

Open Access 01-12-2022 | Care | Research

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

Authors: 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

Published in: Annals of Intensive Care | Issue 1/2022

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Abstract

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
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Metadata
Title
Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial
Authors
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
Publication date
01-12-2022
Publisher
Springer International Publishing
Keyword
Care
Published in
Annals of Intensive Care / Issue 1/2022
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-022-01029-1

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