Electrical Muscle Stimulation in the Development of Acquired Weakness in the Intensive Care Unit in Adult Patients With Severe Sepsis and Septic Shock at the Clinic Hospital of the Univerisity of Chile: Results of a Pilot Randomized Study
Phase: NA
Conditions: Polyneuropathies, Septic Shock, Muscle Weakness
Sponsor: University of Chile

 
 
 
 
 
 
 
 
 
Electrical muscle stimulation in the development of acquired weakness in the 
intensive care unit in adult patients with severe sepsis and septic shock at the 
Clinic Hospital of  the Univerisity of Chile: results of a pilot randomized study 
 
17th November 2016 
 
 
 
 
 
 
 
 
 
 

Study protocol 
SOFA score and septic focus were recorded, and muscle mass was assessed through 
ultrasonography (US) at patient's admission. Randomization was applied to assigned the 
subjects to the intervention group (conventional physical therapy and Electrical muscle 
stimulation) or to the control group (conventional physical therapy). The intervention was 
applied until the day when the subject woke up and was able to respond adequately to at 
least three of five orders of the score of 5 questions test (S5Q): "Look at me", "Open and 
close your eyes", "Nod your head", "Open your mouth and put out your tongue" and "Raise 
your eyebrows after I have counted to five".  If the subject was able to respond less than 
three orders it was considered as not  cooperative and the assessment was repeated the 
next day. If subjects fulfilled three or more orders, we proceeded to assess muscle strength 
measured through the medical research council scale (MRC), maximum inspiratory pressure 
(MIP), SOFA score and we repeated the measurement of muscle mass through US. 
Subsequently, the subjects were followed to record days of invasive mechanical ventilation 
(IMV), presence of weaning failure, days of ICU stay, 28-day mortality, and gait ability at 
hospital discharge. 
Treatment protocol of the control group: conventional physical therapy was used, consisting 
of early passive mobilization and positioning since subjects' day of ICU admission  (levels 0 
and 1 of the adaptation of "Start to move" protocol by Gosselink et al.), as long as it met 
criteria of cardiorespiratory stability according to this protocol. 
Treatment protocol of the intervention group: conventional physical therapy was used, but 
also electrical muscle stimulation (EMS) was applied, starting 48 hours after admission, in 
bilateral biceps brachii and quadriceps femoris (anterior rectus) muscles. The 
electrostimulator that we used is a portable model, Ultima Neo®, Pain Management 
Technologies, Ohio, United States. A set of self-adhesive electrodes was used for each 
patient. The size of the electrodes was 5x5 cm. for the biceps brachii and 5x9 cm. for the 

quadriceps femoris muscles. The parameters used were a frequency of 35 Hz with a pulse 
width of 250 μs for the biceps and a frequency of 50 Hz with a pulse width of 400 μs for the 
cudriceps. In both, biphasic wave was used, 45 minutes of total work, 5 seconds of 
contraction and 10 seconds of relaxation and the intensity was adjusted to the point of a 
visible muscle contraction.