Richard Sola Jr., M.D.
Dr.
Morehouse School of Medicine, United States
Disclosure information not submitted.
Rondi Gelbard, M.D.
Dr.
University of Alabama at Birmingham, United States
Disclosure information not submitted.
Title: Feasibility of an Electrical Muscle Stimulation Protocol to Test for ICU-acquired Weakness
Introduction: Intensive Care Unit (ICU) readmission is associated with increased in-hospital mortality, complications, death and/or costs. Predictive models focused on risk factors for ICU readmission have concluded physical status is crucial. Assessments of physical status may be limited in trauma patients with physical injury or disability. The objective of this study was to determine the feasibility of an electrically stimulated contraction protocol (ESCP) to objectively test ICU-acquired weakness (ICUAW) in trauma patients.>
Methods: Adult trauma patients with recent surgical ICU admission at an urban, academic, Level 1 Trauma Center were recruited. Clinical strength assessments were performed using the medical research council (MRC) scoring system. ESCP was employed on the dominant wrist extensor and ankle dorsiflexor muscle groups. The ESCP was administered at 40 mA for three minutes each at 2 Hz, 4 Hz and 6 Hz. Contraction magnitude was calculated based on the peak-to-peak contraction height for each stimulation period.
Results: Twenty two patients underwent testing. The majority were male (n=16, 89 %), AA race (n=16, 72.7%) median age was 49 [IQR 24;65]. The median body mass index was 23.6 [IQR 21.5;26.9]. Mechanism of injury varied and included: Motor Vehicle Accident, Gunshot, Hip Fracture, Fall, and Seizure. MRC scores had a mean of 48 + 3 (range = 44). Contractions were overall lower in the weak muscles compared to non-weak muscles by 0.90 ± 0.23 G (p = 0.001) in the ankle dorsiflexors and 0.75 ± 0.25 G (p = 0.008) in the wrist extensors.
Conclusion: Our ESCP provides a novel assessment of ICUAW. Given the high likelihood that trauma patients have impairments that may impede traditional assessments, this technique provides an objective alternative and ultimately may improve quality of care for trauma patients.