Acute Crit Care.  2018 Feb;33(1):16-22. 10.4266/acc.2017.00542.

The Effect of Electrical Muscle Stimulation and In-bed Cycling on Muscle Strength and Mass of Mechanically Ventilated Patients: A Pilot Study

• Woo K
• Kim J
• Kim HB
• Choi H
• Kim K
• Lee D
• Na S

• KMID: 2436303
• DOI: http://doi.org/10.4266/acc.2017.00542

Abstract

BACKGROUND
Critically ill patients experience muscle weakness, which leads to functional disability. Both functional electrical stimulation (FES) and in-bed cycling can be an alternative measure for intensive care unit (ICU) patients who are not feasible for active exercise. The aim of this study was to examine whether FES and in-bed cycling have a positive effect on muscle mass in ICU patients.
METHODS
Critically ill patients who received mechanical ventilation for at least 24 hours were included. After passive range of motion exercise, in-bed cycling was applied for 20 minutes, and FES was applied for 20 minutes on the left leg. The right leg received in-bed cycling and the left leg received both FES and in-bed cycling. Thigh circumferences and rectus femoris cross-sectional area (CSA) were assessed with ultrasonography before and after the intervention. Muscle strength was assessed by Medical Research Council scale.
RESULTS
A total of 10 patients were enrolled in this study as a pilot study. Before and after the intervention, the CSA of right rectus femoris increased from 5.08 ± 1.51 cm² to 6.01 ± 2.21 cm², which was statistically significant (P = 0.003). The thigh circumference was also increased and statistically significant (P = 0.006). There was no difference between left and right in regard to FES application. There is no significant change in muscle strength before and after the intervention (right and left, P = 0.317 and P = 0.368, respectively).
CONCLUSIONS
In-bed cycling increased thigh circumferences rectus femoris CSA. Adding FES did not show differences.

Keyword

electric stimulation therapy; muscle weakness; rehabilitation; ultrasonography

MeSH Terms

Critical Illness
Electric Stimulation
Electric Stimulation Therapy
Humans
Intensive Care Units
Leg
Muscle Strength*
Muscle Weakness
Pilot Projects*
Quadriceps Muscle
Range of Motion, Articular
Rehabilitation
Respiration, Artificial
Thigh
Ultrasonography

Figure

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  Figure 1. Thigh circumference and rectus femoris measurement level.

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  Figure 2. Rectus femoris muscle cross-sectional area. A 6–13 MHz linear transducer was placed perpendicular to the long axis of the thigh, at 50% and 25% of the thigh length between the anterior superior iliac spine and the superior margin of the patella. A: cross-sectional area and circumference, B: muscle depth.

• 

  Figure 3. In-bed cycling. A bedside cycle ergometer (Letto 2; MOTOmed, Betzenweiler, Germany) was applied for 20 minutes.

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  Figure 4. Functional electrical stimulation. For 20 minutes, biphasic symmetrical square wave pulse was delivered by a stimulator (Walking Man II; Cyber Medic, Iksan, Korea).

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