Discriminatory Characteristics of Responders and Nonresponders of Patients With Sepsis to Neuromuscular Electrical Stimulation: A Subanalysis of a Randomized Controlled Double-Blinded Trial.

OBJECTIVE

To define the discriminatory characteristics of patients with sepsis or septic shock, as well as responders and nonresponders to the neuromuscular electrical stimulation (NMES) protocol.

DESIGN

This was a subanalysis of a randomized, controlled, double-blind clinical trial.

SETTING

An intensive care unit (ICU) at a private hospital.

PARTICIPANTS

Fifteen adult patients diagnosed with sepsis or septic shock underwent NMES sessions (N=15), among whom 8 were classified as the responder group (RG) and 7 were classified as the nonresponder group (NRG).

INTERVENTIONS: The NMES protocol was initiated at 24 hours after admission with daily sessions. Assessments were performed through ultrasound measurements of the quadriceps femoris muscle and physical function scales.

MAIN OUTCOME MEASURES: Ultrasonographic muscle characteristics and physical function variables.

RESULTS

The rectus femoris thickness was maintained for RG from day 1 to day 4 and reduced by more than 10% for NRG. The Surgical ICU Optimal Mobilization Score (SOMS) statistically differed (p=.04) between RG (2 points; IQR, 0.25-3.5) and NRG (score=0) in the initial assessment. De Morton Mobility Index (DEMMI) in RG increased from 19±20 points to 33±30 points at the final evaluation (p=.04), suggesting higher levels of mobility. There was a strong correlation between the initial SOMS (r=0.72, p=.04), DEMMI (r=0.77, p=.02), and muscle thickness in RG. The NRG exhibited a strong negative correlation between the Sepsis-related Organ Failure Assessment (SOFA) score and rectus femoris thickness at baseline (r=-0.82, p=.04).

CONCLUSIONS

The SOMS and DEMMI could characterize responders in the NMES protocol, whereas the SOFA score did not correlate with responders.