Neuromuscular Electrical Stimulation in Patients With Severe COVID-19 Associated With Sepsis and Septic Shock

Renato Fraga Righetti; Samantha Torres Grams; Wesla Neves da Silva Costa; Leandro Teixeira Saraiva; Isabel Chateaubriand Diniz de Salles; Wellington Pereira Yamaguti

doi:10.3389/fmed.2022.751636

Neuromuscular Electrical Stimulation in Patients With Severe COVID-19 Associated With Sepsis and Septic Shock

Front Med (Lausanne). 2022 Feb 16:9:751636. doi: 10.3389/fmed.2022.751636. eCollection 2022.

Authors

Renato Fraga Righetti¹, Samantha Torres Grams¹, Wesla Neves da Silva Costa¹, Leandro Teixeira Saraiva¹, Isabel Chateaubriand Diniz de Salles¹, Wellington Pereira Yamaguti¹

Affiliation

¹ Hospital Sírio-Libanês, São Paulo, Brazil.

Abstract

Background: Neuromuscular electrical stimulation (NMES) can be applied to critically ill patients. However, its results on muscle strength and functionality in patients with COVID-19 are unknown.

Objective: Evaluate the effects of intervention with NMES on muscle mass and functionality of patients with severe COVID-19 associated with sepsis and septic shock.

Methods: Seven patients with COVID-19 associated with sepsis or septic shock were selected, but only 5 patients completed all days of the intervention with NMES. The intervention was performed by a single physiotherapist on 7 consecutive days in a daily session of 40 min. The outcome measures were the femoris cross-sectional area; thickness of the anterior compartment of the quadriceps muscle; rectus femoris echogenicity; International Classification of Functioning, Disability, and Health (ICF)-muscle strength; PFIT-s, DEMMI, and the SOMS; feasibility, and safety. The patients were evaluated on days 1, 5, and 8.

Results: The rectus femoris cross-sectional area decreased significantly from days 1 to 8, but showed maintenance of the thickness of the anterior compartment of the quadriceps muscle from days 1 to 8. The MRC score increased significantly from days 1 to 5 and kept this improvement until day 8. 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. The PFIT-s increased significantly from days 1 to 5 and improved until day 8 compared to day 5. DEMMI and SOMS score increased significantly on day 8 compared to days 1 and 5.

Conclusion: Rehabilitation with NMES showed improvement in muscle strength and functionality of patients in this study with a potential protective effect on muscle mass loss in patients with critical COVID-19 associated with sepsis and septic shock. This study is the first report of the potential effects of neuromuscular electrical stimulation in patients with severe COVID-19 associated with sepsis and septic shock.

Keywords: COVID-19; muscle mass; neuromuscular electrical stimulation; physiotherapy; sepsis.