Effect of Different Electric Muscle Stimulation in Patients With Severe Sepsis and Respiratory Failure
Effect of Different Electric Muscle Stimulation in Patients With Severe Sepsis and Respiratory Failure
Rationale : Electric muscle stimulation reduced critical-illness related weakness in patients
 with severe sepsis and septic shock. But optimal protocol of the stimulation in unknown.

 Hypothesis: Focal muscle contraction may improved the muscle power and have systemic
 anti-inflammatory via cytokine secretion . The difference of electricity used in upper limb
 or lower limb stimulation may lead to different effect.

 Study design: Stratified randomized parallel control study, comparing Biceps, Quadriceps
 electric muscle stimulation vs. non-stimulation group.

 Participant: adult patients with severe sepsis and acute respiratory failure requiring
 mechanical ventilation.

 Intervention: daily stimulation of bilateral Biceps or Quadriceps by programmed electric
 devices 32 minutes, 5 days/week

 Outcome:

 1. Primary outcome: Ventilator-dependent days

 2. Secondary outcome: change of hand drip muscle
 power/interleukin-1b/interleukin-6/interleukin-8/TNF-alpha
Background : Severe sepsis and septic shock remain top cause of admission to intensive care
 unit. Muscle weakness was found in 70-100% patients with severe sepsis and septic shock
 because of critical-illness induced polyneuropathy and myopathy. Previous study revealed
 electric muscle stimulation (EMS) could reduce such muscle weakness and mechanical
 ventilator-dependent days.

 Hypothesis: different electricity may be needed for minimal contraction of upper or lower
 limb because of their muscle size. Induced muscle contraction may lead to myokine secretion
 and beneficial metabolic and anti-inflammatory effect. Stimulation on Quadriceps may be
 better than on Biceps.

 Participant: adult(older than 20 years-old) patients with severe sepsis.septic shock and
 acute respiratory failure post mechanical ventilation.

 Design: Stratified ( gender and age >50 years-old) Randomized parallel 3 arms study.

 Intervention: Daily stimulation of Biceps of Quadriceps after third days in intensive care
 unit. Programmed electric stimulation device ( HELEX 573 model, strength aggressive. mode,
 45-55Hz 32 minutes per day, voltage 30-70mA)
Inclusion Criteria:

 -  severe sepsis or septic shock patients with acute respiratory failure more than 3 days

 -  adult patients( age>20 years-old)

 Exclusion Criteria:

 -  skin wound/infection near the site of muscle stimulation

 -  acute myocardial infarction within 7 days

 -  pregnant women

 -  uncontrolled epilepsy

 -  no spontaneous breath because of central or cervical spinal neuropathy