Please select the eligibility criteria that correspond to the clinical trial below.
Title: Use of Neuromuscular Electrostimulation (NMES) for Treatment or Prevention of ICU-Associated Weakness
Brief Summary: The purpose of this study is to investigate whether neuromuscular electrostimulation (NMES) will decrease ICU-associated weakness. The investigators believe that 60 minutes of daily NMES will improve strength and function in those who have had extended ICU stays, as well as decrease critical illness myopathy as an etiology of weakness in the critically ill.


Options:
A: Inclusion Criteria:

* (1) Male or female ≥ 21 and ≤ 80 years of age.
* (2) Current HF symptoms consistent with NYHA class III-IV.
* (3) On stable HF pharmacological therapy for at least one month prior to data collection.
* (4) Left ventricular ejection fraction \< 45% documented within 3 months of enrollment (obtained from subjects medical records).
* (5) No planned elective surgery or pacemaker implantation at the time of study initiation.
* (6) Hgb \> 8.0 within 1 month of enrollment (obtained from subjects medical records).
* (7) Willingness to provide written informed consent.

Exclusion Criteria:

* (1) Inability to provide written informed consent.
* (2) Inability to walk on a treadmill.
* (3) Hemodynamically significant valvular heart disease.
* (4) Unstable angina.
* (5) Acute myocardial infarction within the previous 3 months.
* (6) Obstructive hypertrophic cardiomyopathy.
* (7) HF known to be secondary to pericardial disease or uncorrected valvular disease.
* (8) Chronic oxygen therapy.
* (9) Participation in another clinical trial within the past 30 days.
* (10) Participation in a regular exercise within the previous 6 months.
* (11) Previous implantation of a cardiac pacemaker or defibrillator.
* (12) Pregnancy.
* (13) Resting systolic blood pressure \> 200 mmHg.
* (14) Failure to demonstrate the ability to operate the EMS unit.
* (15) Failure to be compliant with at least 75% of the EMS training sessions.
B: Inclusion Criteria:

* all patients admitted in ICU of Evaggelismos Hospital

Exclusion Criteria:

* age \< 18 years
* pregnancy
* pre-existing neuromuscular disease (e.g. Gravis)
* connective tissue disease
* fractures or skin lesions that do not allow the implementation of EMS
* BMI \> 35 kg/m2
* brain death
* terminal disease
* length of stay \< 48 hours
* presence of pacemaker
C: Inclusion Criteria:

* 1 day of mechanical ventilation with an expectation of requiring ≥2 additional days of ICU stay in a Johns Hopkins Intensive Care Unit (ICU)

Exclusion Criteria:

* Unable to understand or speak English due to language barrier or cognitive impairment prior to admission
* Unable to independently transfer from bed to chair at baseline prior to hospital admission
* Known primary systemic neuromuscular disease (e.g. Guillian-Barre) at ICU admission
* Known intracranial process that is associated with localizing weakness (e.g. cerebral vascular accident) at ICU admission
* Transferred from another ICU outside of the Johns Hopkins system after \>4 consecutive days of mechanical ventilation
* Moribund (i.e. \>90% probability of patient mortality in the next 96 hours)
* Anticipated transfer to another ICU for care (e.g. awaiting organ transplantation and transfer to surgical ICU)
* Any pacemaker (e.g., cardiac, diaphragm) or implanted cardiac defibrillator
* Pregnancy
* Body mass index ≥35 kg/m2
* Any limitation in life support other than a sole no-CPR order
* Known or suspected malignancy in the legs
* Unable to treat or evaluate both lower extremities (e.g., bilateral amputation, bilateral skin lesions)
* ICU length of stay \>7 days prior to enrollment
D: Inclusion Criteria:

* diagnosis of chronic obstructive pulmonary disease
* being 35-75 years of age
* being eligible to participate in endurance trainin
* no acute exacerbation in last month, no change in drugs and no usage of antibiotics in last three weeks

Exclusion Criteria:

* medical conditions which could place patient at risk during neuromuscular electrical stimulation and exercise training (orthophedic and neuromuscular disorders, metal implants in the lower limbs, advanced heart failure, aortic stenosis, deep venous thrombosis a cardiac pacemaker, \>50 mmHg pulmonary artery pressure and/or an acute exacerbation of symtomps in the preceeding four weeks)
* being unable to understand the questionnaires and unable to cooparate.

Answer: C