Lago Alessandra Fabiane, de Oliveira Anamaria Siriani, de Souza Hugo Celso Dutra, da Silva João Santana, Basile-Filho Anibal, Gastaldi Ada Clarice
Department of Physiotherapy, Rehabilitation and Functional Performance Post Graduation Program Department of Biochemistry and Immunology Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.
Medicine (Baltimore). 2018 Feb;97(6):e9736. doi: 10.1097/MD.0000000000009736.
Septic shock is a potentially fatal organ dysfunction caused by an imbalance of the host response to infection. The changes in microcirculation during sepsis can be explained by the alterations in the endothelial barrier function. Endothelial progenitor cells (EPCs) are a potential recovery index of endothelial function and it an increase in response to neuromuscular electrical stimulation (NMES) was demonstrated. Therefore, the objective of this study is to investigate the effects of NMES in patients with septic shock.
It is a study protocol for a randomized cross-over design in an intensive care unit of a tertiary University hospital. Thirty-one patients aged 18 to 65 years. The study will be divided in 2 phases: the phase one will be held in the first 72 hours of septic shock and the phase two after 3 days of first assessment. Patients will be randomly selected to the intervention protocol (decubitus position with the limbs raised and NMES) and control protocol (decubitus position with the limbs raised without NMES). After this procedure, the patients will be allocated in group 1 (intervention and control protocol) or group 2 (control and intervention protocol) with a wash-out period of 4 to 6 hours between them. The main outcome is mobilization of EPCs. The secondary outcome is metabolic and hemodynamic data. A linear mixed model will be used for analysis of dependent variables and estimated values of the mean of the differences of each effect.
脓毒性休克是一种由宿主对感染的反应失衡引起的潜在致命性器官功能障碍。脓毒症期间微循环的变化可通过内皮屏障功能的改变来解释。内皮祖细胞（EPCs）是内皮功能的一个潜在恢复指标，并且已证实其对神经肌肉电刺激（NMES）的反应会增加。因此，本研究的目的是探讨NMES对脓毒性休克患者的影响。
这是一项在一所三级大学医院重症监护病房进行的随机交叉设计的研究方案。31名年龄在18至65岁之间的患者。该研究将分为两个阶段：第一阶段将在脓毒性休克的前72小时进行，第二阶段在首次评估3天后进行。患者将被随机分配到干预方案（肢体抬高的卧位并接受NMES）和对照方案（肢体抬高的卧位但不接受NMES）。在此程序之后，患者将被分配到第1组（干预和对照方案）或第2组（对照和干预方案），两组之间有4至6小时的洗脱期。主要结局是EPCs的动员。次要结局是代谢和血流动力学数据。将使用线性混合模型分析因变量以及每种效应差异均值的估计值。
