![]() Teener JW, Rich MM: Dysregulation of sodium channel gating in critical illness myopathy. Gerovasili V, Tripodaki E, Karatzanos E, Pitsolis T, Markaki V, Zervakis D, Routsi C, Roussos C, Nanas S: Short-term systemic effect of electrical muscle stimulation in critically ill patients. Nuhr MJ, Pette D, Berger R, Quittan M, Crevenna R, Huelsman M, Wiesinger GF, Moser P, Fialka-Moser V, Pacher R: Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure. Routsi C, Gerovasili V, Vasileiadis I, Karatzanos E, Pitsolis T, Tripodaki ES, Markaki V, Zervakis D, Nanas S: Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial. Similar to the studies of mechanical ventilation and weaning that require the standardization of multiple non-ventilator practices, future attempts to test interventions to preserve neuromuscular function in critically ill patients must account for these and other important co-factors. In their study of structured physical therapy in ventilated patients, baseline functional status was determined and their intervention was applied in the context of rigorous sedation interruption ensuring that excess 'immobilization days' were minimized. What is the baseline physical function of these ICU patients prior to their acute illness? How were sedative agents handled? What were the baseline physical therapy practices of the base ICU and, therefore, the control group? In many ways the example given to us by William Schweickert and colleagues should serve as a guide for future researchers in this area of critical care research. However, in studies of physical function other variables have to be accounted for. ![]() Typical outcomes for interventions in severe sepsis patients have been survival or organ failure resolution. This is a very different outcome than survival. In fact, this article and the interpretation of its results raise significant issues as to the essential data that need to be reported in studies of critically ill patients designed to measure physical strength as their outcome. If this were true, it could explain why control patients could possibly remain in the ICU longer than their TEMS counterparts as the duration of time patients spend in coma is highly associated with the development of ICU-acquired weakness and muscle atrophy. Is it possible that TEMS at the doses used is mentally alerting? This is an intriguing idea given that patients in the TEMS group in this study were less often excluded due to coma (11 in the TEMS group versus 22 in the control group) and therefore unable to be examined for strength. ![]() Was this because capture could not be achieved or were they simply missed? For this specific question we await the results of studies focusing on the use of TEMS in sepsis patients ( identifier NCT01071343). Along these lines, the dose of electricity required to activate muscles in this study were not reported and several patients were not included in the analysis because they received no TEMS. ![]() This particular study appears to have a relative minority of patients experiencing sepsis at ICU admission, leading to questions about its efficacy in this population. First, why would electrical stimulation of only the lower extremities impact overall strength? While systemic effects of TEMS have been observed in the form of improved microcirculation, is this enough to improve global strength in non-stimulated muscle groups? Severe sepsis, a disease long associated with a high rate of critical illness polyneuromyopathy, may actually lead to electrically unexcitable muscles. Unfortunately, despite the magnitude of the observed effect in this patient population, many important questions remain unanswered.
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