Matsuo T1, Inoue K2, Saito K1, Otsuka S1, Hojo Y1, Ishihara K1, Niho Y1, Nakai K1, Ono M1, Ninomiya K1, Hiraoka A2, Sakaguchi T2
1Sakakibara Heart Institute of Okayama, Department of Rehabilitation, Okayama, Japan, 2Sakakibara Heart Institute of Okayama, Department of Cardiovascular Surgery, Okayama, Japan
Background: It is difficult to gain enough voluntary contraction and the amount of physical activity after cardiac surgery because of requiring to control hemodynamics and bleeding. Neuromuscular electrical stimulation (NMES) has known as a feasible therapy for neuromuscular activation in sedated patients, so this intervention has been spreading to utilize in intensive care unit (ICU). However, the effect of NMES on muscle mass and strength are still unclear in critically ill patients.
Purpose: To investigate the effectiveness of NMES to prevent skeletal muscle weakness in the early postoperative phase among patients who underwent cardiac surgery.
Methods: In this randomized trial, 72 patients who underwent an elective cardiac surgery were randomly separated into two groups. In the intervention group, quadriceps femoris were electrically stimulated bilaterally from postoperative days (PODs) 1 to 7 in addition to postoperative mobilization program (NMES group). In the control group, patients underwent postoperative mobilization program (control group). The primary outcomes were muscle layer thickness (MLT) measured by ultrasonography at preoperative day and 7PODs. Measuring parts of MLT were left anterior thigh (between the lateral condyle and greater trochanter) and left anterior upper arm (between acromion and olecranon), and they were measured the raw muscle thickness at maximum voluntary contraction (MVC) and at rest, respectively. The secondary functional outcomes were average mobility level, which were assessed at ICU and hospital discharges, and compared the day of standing at the bedside and independent walking as the rehabilitation progress.
Results: MLT of thigh at rest in the NMES group (26.94±6.01mm at preoperative day, 26.29±5.80mm at 7PODs and 25.07±4.82mm at discharge) had no significant differences. That in the control group (25.74±6.06mm at preoperative day, 24.01±5.12mm at 7PODs and 24.37±4.32mm at discharge) was also not significantly different. Although a significant difference was not recognized in MLT of thigh at MVC in the NMES group (34.24±7.18mm at preoperative day, 33.03±6.76mm at 7PODs and 33.11±6.50mm at discharge), that in the control group decreased significantly from 34.76±6.79mm at preoperative day to 30.79±6.00mm at 7PODs (p 0.05). The comparison of MLT of thigh at MVC at preoperative day and 32.53±5.31mm at discharge, at 7PODs and at discharge showed no significant difference. NMES had no significant effect on MLT of upper arm. Moreover, there was not any significant difference between both groups in average mobility level and the rehabilitation progress.
Conclusion(s): NMES might prevent to decrease in muscle mass of quadriceps femoris in the early postoperative phase after cardiac surgery.
Implications: Perioperative skeletal muscle weakness after cardiovascular surgery may cause to delay the early postoperative recovery and poor prognosis. Therefore, it is suggested that NMES could be effective to attenuate postoperative muscle weakness.
Keywords: Electrical Stimulation Therapy, Perioperative Muscle Weakness, Cardiac Surgery
Funding acknowledgements: This work was unfunded.
Purpose: To investigate the effectiveness of NMES to prevent skeletal muscle weakness in the early postoperative phase among patients who underwent cardiac surgery.
Methods: In this randomized trial, 72 patients who underwent an elective cardiac surgery were randomly separated into two groups. In the intervention group, quadriceps femoris were electrically stimulated bilaterally from postoperative days (PODs) 1 to 7 in addition to postoperative mobilization program (NMES group). In the control group, patients underwent postoperative mobilization program (control group). The primary outcomes were muscle layer thickness (MLT) measured by ultrasonography at preoperative day and 7PODs. Measuring parts of MLT were left anterior thigh (between the lateral condyle and greater trochanter) and left anterior upper arm (between acromion and olecranon), and they were measured the raw muscle thickness at maximum voluntary contraction (MVC) and at rest, respectively. The secondary functional outcomes were average mobility level, which were assessed at ICU and hospital discharges, and compared the day of standing at the bedside and independent walking as the rehabilitation progress.
Results: MLT of thigh at rest in the NMES group (26.94±6.01mm at preoperative day, 26.29±5.80mm at 7PODs and 25.07±4.82mm at discharge) had no significant differences. That in the control group (25.74±6.06mm at preoperative day, 24.01±5.12mm at 7PODs and 24.37±4.32mm at discharge) was also not significantly different. Although a significant difference was not recognized in MLT of thigh at MVC in the NMES group (34.24±7.18mm at preoperative day, 33.03±6.76mm at 7PODs and 33.11±6.50mm at discharge), that in the control group decreased significantly from 34.76±6.79mm at preoperative day to 30.79±6.00mm at 7PODs (p 0.05). The comparison of MLT of thigh at MVC at preoperative day and 32.53±5.31mm at discharge, at 7PODs and at discharge showed no significant difference. NMES had no significant effect on MLT of upper arm. Moreover, there was not any significant difference between both groups in average mobility level and the rehabilitation progress.
Conclusion(s): NMES might prevent to decrease in muscle mass of quadriceps femoris in the early postoperative phase after cardiac surgery.
Implications: Perioperative skeletal muscle weakness after cardiovascular surgery may cause to delay the early postoperative recovery and poor prognosis. Therefore, it is suggested that NMES could be effective to attenuate postoperative muscle weakness.
Keywords: Electrical Stimulation Therapy, Perioperative Muscle Weakness, Cardiac Surgery
Funding acknowledgements: This work was unfunded.
Topic: Cardiorespiratory; Critical care
Ethics approval required: Yes
Institution: The Sakakibara Heart Institute of Okayama
Ethics committee: The Sakakibara Heart Institute of Okayama
Ethics number: 20170730
All authors, affiliations and abstracts have been published as submitted.
