K. Nakamura et al.
708
Fig. 2. Patient flowchart. A total of 220 patients were admitted
to the intensive care unit (ICU) during the study period.
Of these, 126 were excluded and 94 included in the study.
Forty-seven patients per group were randomly assigned to a
control group and electrical muscle stimulation (EMS) group,
respectively. Sixteen patients in the control group and 21 in
the EMS group were finally included in femoral muscle analysis
on day 10. DNR: do not attempt resuscitation, CT: computed
tomography, ECMO: extracorporeal membrane oxygenation.
Outcomes for the subjects in whom final muscle
volume was analysed are shown in Table III and Fig.
3. Femoral muscle volume decreased significantly
from day 1 to day 10 in both groups (p<0.0001). The
mean rate of volume loss was 17.7% (SD 10.8%) (95%
confidence interval; 95% CI 11.9–23.5) for controls
and 10.4% (SD 10.1%) (95% CI 5.8–15.1) for EMS
patients. The EMS group had significantly reduced
the rate of muscle volume loss (41.2%) (p = 0.04).
Mean Barthel Index at discharge was 29.0 (SD 18.8)
(95% CI 12.0–46.0) for controls and 50.4 (SD 31.6)
(95% CI 23.9–76.9) for EMS patients. Although total
Table II. Basic characteristics of each group for final femoral muscle analysis. Basic characteristics were not significantly different.
Severe patients with mean sequential organ failure assessment (SOFA) score over 8 and Acute Physiology and Chronic Health Evaluation
(APACHEII) score over 20 were included in the final analysis. Sedatives and analgesics administered when the first rehabilitation was
introduced on day 2 were described with mean value (maximum and minimum)
Age, years, mean (SD)
Sex (male), n (%)
SOFA, mean (SD)
APACHEII, mean (SD)
Adjunctive treatments
Mechanical ventilation, n (%)
Renal replacement therapy, n (%)
Steroids, days, n (%)
Sedatives and analgesics, days, n (%), mean (SD)
Propofol, mg/h, n (%), mean (range)
Midazolam, mg/h, n (%), mean (range)
Fentanyl, μg/h, n (%), mean (range)
Dexmedetomidine, μg/h, n (%), mean (range)
Vasopressive agents, days, n (%), mean (range)
Muscle relaxants, days, n (%)
Nutrition on 7 day, mean (SD)
Body weight
Total calories, kcal/day
Total protein, g/day
Enteral/total feeding, %
Complicating diseases, n (%)
Sepsis
Heart failure
Stroke
Cardiopulmonary arrest
Post-surgery
Respiratory failure
Trauma
Endocrine or metabolic disorder
EMS: electrical muscle stimulation group; SD: standard deviation.
www.medicaljournals.se/jrm
EMS
n = 21 Control
n = 16 p-value
76.6 (11.0)
14 (66.7)
8.6 (3.7)
22.8 (6.2) 74.6 (13.1)
11 (68.8)
8.7 (2.8)
22.9 (3.9) 0.61
0.89
0.96
0.97
17 (81.0)
8 (38.1)
7 (33.3)
21 (100), 5.5 (2.7)
21 (100), 11.8 (4–20)
1 (4.8), 2.0 (2–2)
15 (71.4), 72.8 (40–100)
8 (38.1), 27.6 (16–32)
19 (90.5), 6.0 (3.0)
0 (0), 0 13 (81.3)
7 (43.8)
5 (31.3)
16 (100), 5.8 (3.3)
13 (81.3), 12.5 (4–18)
1 (6.3), 3.0 (3–3)
12 (75.0), 68.8 (40–100)
7 (43.8), 25.8 (16–32)
13 (86.7), 5.5 (2.1)
1 (6.7), 1 0.98
0.73
0.89
1
54.7 (11.9)
1,258 (334
52.3 (17.6)
63.1 (25.5) 57.0 (10.8)
1,284 (379)
50.8 (16.3)
71.6 (21.8) 0.69
0.87
0.84
0.54
20 (95.2)
13 (61.9)
8 (38.1)
2 (9.5)
5 (23.8)
14 (66.7)
1 (4.8)
7 (33.3) 15 (93.8)
10 (62.5)
4 (25.0)
2 (12.5)
3 (18.8)
9 (56.2)
0 (0)
8 (50.0) 0.84
0.97
0.40
0.77
0.71
0.52
0.28
0.31
0.72
0.19