Efeitos da eletroestimulação na prevenção de perda de massa muscular e na qualidade muscular em pacientes com COVID-19 submetidos à ventilação mecânica invasiva

Abstract

Objectives: To evaluate the effects of neuromuscular electrical stimulation (NMES) in muscle mass loss and/or muscle strength reduction prevention in patients with COVID-19, submitted to invasive mechanical ventilation (IMV) in a period longer than 48 hours. And analyze whether different protocols related to the number of contractions induced by NMES provide diferente outcomes of the variables. Methods: Randomized clinical trial with individuals admitted to an intensive care unit due to COVID-19 and submitted to invasive mechanical ventilation for at least 48 hours. The control group received conventional physical therapy treatment and two other groups, in addition to the conventional treatment, performed NMES with 100 and 150 daily contractions, respectively. The primary outcomes were cross-sectional area (CSA), echointensity, and rectus femoris muscle thickness assessed on the first and seventh days of IMV by ultrasound. Results: 39 participants were randomized, 13 in each group. On the sixth day, before the end of the study, one individual in the Control Group died. In the post-hoc analysis, there was a lower loss of cross-sectional area of the rectus femoris in the groups 100 CD (102 mm3±23 , p <0.05; p = 0.004) and 150 CD (114 mm3 ±27, p = 0.003) compared to the Control Group and there was no difference between the 100 CD and 150 CD groups (mean difference 56mm±28, p = 0.14). For the outcome ecointensity, there was a lower loss of muscle quality in the 100 CD (mean difference 8 a.u ±3) and 150 CD (mean difference 7 a.u ±4) groups compared to the Control Group. There was no difference between the 100 CD and 150 CD groups. For the outcome thickness, no significant differences were found between the 3 groups (p=013). There was no difference in primary outcomes between the 100 CD and 150 CD protocols. Conclusion: Neuromuscular electrostimulation, performed early and with at least 100 contractions daily, was effective in reducing muscle mass loss and delaying the decrease in rectus femoris muscle quality in the first seven days of IMV in patients with COVID -19.