Define the discriminatory characteristics of patients with sepsis or septic shock, responders and non-responders to an NMES protocol.
This is a sub-analysis of a controlled, randomized, double-blind clinical trial involving adult patients (≥18 years) admitted to the ICU with a diagnosis of SIRS/sepsis or septic shock. The study was conducted in an ICU of a hospital in São Paulo, following approval from the ethics committee for research involving human subjects under number 3.999.139. The NMES protocol was initiated 24 hours after admission to the ICU, with daily sessions lasting 40 minutes. Evaluations were conducted using ultrasound measurements of the quadriceps femoris, as well as the Surgical Intensive Care Unit Optimal Mobilization Score (SOMS), De Morton Mobility Index (DEMMI), Physical Function in Intensive Care Test-scored (PFIT-S), and the Medical Research Council (MRC) scale for strength assessment.
Fifteen patients underwent NMES sessions, with 8 classified as the "Responder Group" (RG) and 7 classified as the "Non-Responder Group" (NRG). There was no statistical difference between the groups regarding clinical characteristics. Among the physical function characteristics, the Surgical Intensive Care Unit Optimal Mobilization Score (SOMS) showed a difference between patients in the RG (2 points; IQR 0.25 – 3.5) and the NRG (score 0), with p = 0.04 at the initial assessment. In the De Morton Mobility Index (DEMMI), the RG increased from 19 ± 20 points to an average of 33 ± 30 points at the final assessment (p = 0.04), representing an average change of 14.7 points, exceeding the minimum important difference indicated by the instrument (6.73 points), suggesting that this group had higher levels of mobility. Correlation analyses demonstrated a strong correlation between the initial SOMS (r = 0.72; p = 0.04) and DEMMI (r = 0.77; p = 0.02) with the initial thickness of the rectus femoris for the RG. The strength assessment did not show a statistical difference when comparing the groups. The NRG exhibited a strong negative correlation between the SOFA severity score and the initial thickness of the rectus femoris (r = -0.82; p = 0.04).
The physical function characteristics assessed by the SOMS and DEMMI instruments were able to identify the patients who responded to the NMES protocol. The SOFA score significantly correlated with patients who were non-responders to the NMES protocol. Patients who responded to the NMES protocol showed improvement in physical functions.
The SOMS and DEMMI can be used in clinical practice to identify patients who may benefit from NMES, making the therapy more precise and tailored to patients' clinical and functional needs.
muscle mass
critical care
