Miyagishima Saori, Akatsuka Masayuki, Tatsumi Hiroomi, Takahashi Kanako, Bunya Naofumi, Sawamoto Keigo, Narimatsu Eichi, Masuda Yoshiki
Department of Rehabilitation, Division of Physical Therapy, Japan Healthcare University Faculty of Health Sciences, Sapporo, JPN.
Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, JPN.
Cureus. 2024 Oct 7;16(10):e71029. doi: 10.7759/cureus.71029. eCollection 2024 Oct.
The COVID-19 pandemic has led to an unprecedented increase in cases of acute respiratory distress syndrome (ARDS). In such cases, deep sedation using sedatives and muscle relaxants is commonly used to prevent patient self-inflicted lung injury during the early phase. However, such sedation limits the ability to perform early rehabilitation, leading to ICU-acquired muscle weakness (ICU-AW) and a worse prognosis.
This study aimed to clarify the preventive effect of neuromuscular electrical stimulation (NMES) during deep sedation on ICU-AW and physical function at discharge in critically ill patients with COVID-19 with ARDS.
A retrospective, single-center study was conducted on patients admitted to the ICU or advanced critical care center with severe COVID-19 with ARDS between March 1, 2020, and March 31, 2022. Patients who were managed with the Richmond Agitation-Sedation Scale between -4 and -5 for at least three days were included. Patients in the NMES group received NMES within two days of deep sedation, whereas those in the non-NMES group did not. The primary endpoint was the incidence of ICU-AW at discharge from the ICU, and the secondary endpoints included physical activity levels, skeletal muscle mass index, time to active mobilization, and Barthel index (BI) at discharge. Statistical analyses included Pearson's chi-squared test, Fisher's exact test, and multiple logistic and linear regression analyses.
Of the 129 patients, 68 (54 males and 14 females) were included after applying the exclusion criteria, with 38 in the NMES group and 30 in the non-NMES group. The incidence of ICU-AW was significantly lower in the NMES group (28.95% vs. 56.67%, p = 0.0211). NMES implementation (OR: 0.20, p = 0.03), ventilator weaning (OR: 0.10, p = 0.01), and duration of deep sedation (OR: 0.81, p < 0.01) were significant predictors of ICU-AW. Higher ICU Mobility Scale scores and shorter time to active mobilization were associated with a higher BI at discharge.
Early rehabilitation using NMES during deep sedation may prevent ICU-AW in critically ill patients with COVID-19 with ARDS. NMES is associated with a reduced risk of ICU-AW and improved functional independence at discharge. This procedure can be safely performed in sedated patients and may help prevent ICU-AW, supporting early mobilization strategies in ARDS rehabilitation.
新型冠状病毒肺炎（COVID-19）大流行导致急性呼吸窘迫综合征（ARDS）病例前所未有的增加。在这类病例中，早期通常使用镇静剂和肌肉松弛剂进行深度镇静，以防止患者出现自伤性肺损伤。然而，这种镇静会限制早期康复的能力，导致重症监护病房获得性肌无力（ICU-AW）并使预后更差。
本研究旨在阐明深度镇静期间神经肌肉电刺激（NMES）对患有ARDS的COVID-19重症患者的ICU-AW及出院时身体功能的预防作用。
对2020年3月1日至2022年3月31日期间入住重症监护病房（ICU）或高级重症护理中心、患有严重COVID-19且伴有ARDS的患者进行了一项回顾性单中心研究。纳入了使用里士满躁动镇静量表评分在-4至-5之间至少持续三天的患者。NMES组患者在深度镇静的两天内接受NMES治疗，而非NMES组患者未接受。主要终点是ICU出院时ICU-AW的发生率，次要终点包括出院时的身体活动水平、骨骼肌质量指数、主动活动时间和巴氏指数（BI）。统计分析包括Pearson卡方检验、Fisher精确检验以及多元逻辑回归和线性回归分析。
129例患者中，应用排除标准后纳入68例（54例男性和14例女性），其中NMES组38例，非NMES组30例。NMES组ICU-AW的发生率显著更低（28.95%对56.67%，p = 0.0211）。实施NMES（比值比：0.20，p = 0.03）、撤机（比值比：0.10，p = 0.01）和深度镇静持续时间（比值比：0.81，p < 0.01）是ICU-AW的显著预测因素。更高的ICU活动量表评分和更短的主动活动时间与出院时更高的BI相关。
在深度镇静期间使用NMES进行早期康复可能预防患有ARDS的COVID-19重症患者发生ICU-AW。NMES与降低ICU-AW风险及出院时改善功能独立性相关。该操作可在镇静患者中安全进行，可能有助于预防ICU-AW，支持ARDS康复中的早期活动策略。
