Background: Electrical stimulation has been used in critical patients as an adjunct strategy of early rehabilitation. In septic or septic shock patients there are reports of only two studies in the literature, with conflicting results. Objective: To evaluate the effects of electrical stimulation in the prevention of muscle mass loss in patients admitted to the ICU with systemic inflammatory response syndrome (SIRS), sepsis or septic shock. Methods: This is a randomized, controlled, double-blind clinical trial. Thirty-six patients with a diagnosis of SIRS, sepsis or septic shock (including patients with sepsis due to the new coronavirus - COVID-19) will be randomly assigned to experimental group and sham group. They will be evaluated in relation to muscle mass, peripheral muscle strength and functional status. They will also be submitted to the collection of inflammatory, metabolic, damage and muscular trophism markers. Expected results: Electrical stimulation is expected to be able to prevent loss of muscle mass in patients admitted to the ICU with SIRS, sepsis or septic shock. In addition, it is expected to be able to preserve strength in this population without increasing the pro-inflammatory or metabolic response.
This is a randomized, controlled, double-blind clinical trial. Thirty-six patients with a diagnosis of SIRS, sepsis or septic shock (including patients with sepsis due to the new coronavirus - COVID-19) will be randomly assigned to experimental group and sham group.They will be evaluated in relation to muscle mass, peripheral muscle strength and functional status. They will also be submitted to the collection of inflammatory, metabolic, damage and muscular trophism markers.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
36
Experimental Electrical Stimulation (100Hz) during 40 minutes
Sham Electrical Stimulation (5Hz) during 40 minutes
Active and passive exercises, and walking.
Hospital Sírio-Libanês
São Paulo, Brazil
Muscle mass
Cross-sectional area
Time frame: 8 days
Muscle mass
Thickness
Time frame: 8 days
Peripheral muscle strength
Medical Research Council Scale will be used to measure the peripheral muscle strength. The patient's effort is graded on a scale of 0-5: Grade 5: Muscle contracts normally against full resistance. Grade 4: Muscle strength is reduced but muscle contraction can still move joint against resistance. Grade 3: Muscle strength is further reduced such that the joint can be moved only against gravity with the examiner's resistance completely removed. As an example, the elbow can be moved from full extension to full flexion starting with the arm hanging down at the side. Grade 2: Muscle can move only if the resistance of gravity is removed. As an example, the elbow can be fully flexed only if the arm is maintained in a horizontal plane. Grade 1: Only a trace or flicker of movement is seen or felt in the muscle or fasciculations are observed in the muscle. Grade 0: No movement is observed. The total score ranges from 0 (complete tetraparesis) to 60 points (normal muscle strength).
Time frame: 8 days
Functional status
Functional status will be assessed using the Surgical Intensive Care Unit Optimal Mobilization Score. This score classifies mobility from 0 to 4: The SOMS "0 - No mobility" indicates that no mobilization should be considered due to the patients' clinical status. SOMS "1 - Passive mobilization" indicates that passive mobilization can be carried out in bed. SOMS "2 - Sitting" demonstrates that the patient is already able to sit on the bed or in a chair. SOMS "3 - Standing", indicates that the patient can perform orthostatism, with or without assistance. The highest level of SOMS "4 - Ambulation", shows that the patient is capable of ambulation.
Time frame: 8 days
Inflammatory
IL-1α
Time frame: 5 days
Inflammatory
IL-6
Time frame: 5 days
Inflammatory
IL-8
Time frame: 5 days
Inflammatory
IL-10
Time frame: 5 days
Inflammatory
IL-15
Time frame: 5 days
Inflammatory
MIP-1α
Time frame: 5 days
Inflammatory
TNF-α
Time frame: 5 days
Inflammatory
CRP
Time frame: 5 days
Metabolic, damage and muscular trophism markers
Lactate
Time frame: 5 days
Metabolic, damage and muscular trophism markers
CPK
Time frame: 5 days
Metabolic, damage and muscular trophism markers
IGF-1
Time frame: 5 days
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