Neuromuscular electrical stimulation prevents the skeletal muscle weakness in patients with severe COVID-19 associated with sepsis and septic shock: a case series

ABSTRACT

Introduction: Neuromuscular electrical stimulation (NMES) results on muscle strength and functionality in patients with severe coronavirus disease 2019 (COVID-19) associated with sepsis and septic shock are unknown. Methods: Patients with severe COVID-19 associated with sepsis or septic shock were selected. The NMES intervention was performed on 7 consecutive days in a daily session of 40 min (frequency of 100 Hz and a pulse of 350 μs). Electrodes were positioned in the vastus medialis and vastus lateralis muscles, and inguinal region. The outcome measures were the femoris cross-sectional area (RF-CSA), thickness of the anterior compartment of the quadriceps muscle, rectus femoris echogenicity, International Classification of Functioning, Disability, and Health (ICF)-muscle strength, Physical Function ICU Test-scored (PFIT-s), Morton Mobility Index (DEMMI), and the Surgical Intensive Care Unit Optimal Mobilization Score (SOMS). The patients were evaluated on days 1, 5, and 8. Results: The RF-CSA area decreased significantly (- 16.9%;p < 0.05) from days 1 to 8, but showed maintenance of the thickness of the anterior compartment of the quadriceps muscle (- 3.20%;p = 0.3) from days 1 to 8. These patients showed a reduction of 2.1% per day in the rectus femoris cross-sectional area and 0.3% per day in the thickness of the anterior compartment of the quadriceps muscle during 8 days. Patients showed maintenance of the echogenicity (1.3%;p = 0.8) from days 1 to 8 with an increase of 0.16% per day. All patients showed an increase in the MRC score and reduction of the ICF-muscle strength, meaning improved muscle strength from days 1 to 8 (p < 0.05). The PFIT-s increased from days 1 to 5 and improved until day 8 compared to day 5 (p < 0.05). DEMMI and SOMS scores increased on day 8 compared to days 1 and 5 (p < 0.05). Conclusions: NMES showed a protective effect on muscle strength and improve the functionality of patients with several COVID-19 associated with sepsis and septic shock.