Effects of protein, muscle rehabilitation and trunk neuromuscular electrostimulation in patients with prolonged mechanical ventilation: a prospective, randomized controlled pilot study.

چکیده اصلی

BACKGROUND: Attenuating diaphragmatic dysfunction is important in patients with prolonged mechanical ventilation (PMV). The clinical impact of protein supplementation, core muscle rehabilitation and neuromuscular electrostimulation (NMES) in patients with PMV remains unknown. STUDY DESIGN AND METHODS: We conducted a single center, prospective, randomized controlled pilot study for critically ill patients with PMV . All enrolled patients were randomly assigned into four groups: (1) usual care (UC) + high-protein diet (HP); (2) UC + HP + core muscle rehabilitation; (3) UC + HP + core muscle rehabilitation + NMES; and (4) UC. The interventions were maintained for 21 days. Primary outcomes were successful weaning from the ventilator and the duration of mechanical ventilation. Secondary outcomes were length of hospital stay and in-hospital mortality. RESULTS: A total of 100 patients were enrolled, with 10 in the UC group and 30 each in the other three groups. Nine patients discontinued the trial early. The mean compliance rates of core muscle rehabilitation and NMES were nearly 90%. The patients in group 3 had the highest weaning rate followed by group 2 and group 1, and the difference was significant compared to group 4 (87%, 73%, 67% and 30%, p = 0.0071). The patients in group 3 also had the shortest duration of mechanical ventilation followed by group 1 and group 2, and the difference was significant compared to group 4 (41.1 ± 12.9, 56.5 ± 24.1, 57.1 ± 29.9 and 74.4 ± 27.1 days, p = 0.0006). The length of hospital stay and in-hospital mortality were comparable in the four groups. CONCLUSION: Combining high-protein supplementation, core rehabilitation, and NMES is feasible and may facilitate ventilator weaning in PMV patients. Larger multicenter randomized trials are warranted. CLINICAL TRIAL REGISTRATION NUMBER: This trial was registered with ClinicalTrials.gov (NCT05932134, Sep 2023) and is closed to new participants.

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