Safety Evaluation of Functional Electrical Stimulation (FES) Cycling in Intensive Care Unit Patients

Muscle Weakness Clinical Trial

— FES Cycling  

Official title:

Study of Feasibility and Safety of Functional Electrical Stimulation (FES) Cycling in Intensive Care Unit Patients

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03526211
• Other study ID #: 18CH005
• Secondary ID: 2018-A00541-54
• Status: Completed
• Phase: N/A
• Start date: July 24, 2018
• Est. completion date: June 18, 2019

Study information

• Verified date: June 2019
• Source: Centre Hospitalier Universitaire de Saint Etienne
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Intensive care unit acquired muscle weakness (ICUAW), is a common disease which influence rehabilitation, extend mechanical ventilation and length of stay in intensive care unit, and affect quality of life at hospital discharge.

To prevent ICUAW, different strategies of early mobilization are recommended. But all cannot be applied in all ICU patients. Some of them benefit from heavy therapies like circulatory assistance or renal replacement therapy for example, that limit mobilization.

Cycloergometer is a tool that allows continuous passive mobilization in bedridden and even unconscious patients.

Neuromuscular electrical stimulation (NMES) is an alternative that helps preserve muscle mass and limit muscle atrophy.

Early bedside cycle exercise coupled with NMES is an interesting new approach where application of an electrical stimulation along specific motor nerves on each lower limb, generates muscles contractions and pedaling on cycloergometer.

The aim of this study is to evaluate safety and feasibility of this coupled technique called Functional Electrical Stimulation (FES) Cycling, in ICU patients.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 20
• Est. completion date: June 18, 2019
• Est. primary completion date: June 18, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Age = 18 years

• Deeply sedated (Riker 1-2) patients, admitted in intensive care unit B of ST-Etienne hospital

• Without curare since 12 hours

• Normothermic or with a controlled fever (central temperature between 36 and 38°C)

• Without haemodynamic instability (mean arterial pressure > 65mmHg and < 120mmHg, systolic arterial pressure > 90mmHg and < 200mmHg, Norepinephrine < 4mg/h)

• Without respiratory instability (respiratory rate < 35/min, pulse oxymetry > 90%, inspired oxygen fraction < 60%, PaO2/FiO2 ratio > 250, Peep < 10cmH2O, with invasive mechanical ventilation)

• Without neurological instability (diastolic velocities in mean cerebral artery > 30cm/s, mean velocities > 50cm/s, pulsatility index < 1.2, intracranial pressure < 20mmhg, brain tissue oxygenation tension > 15mmHg)

• Patient whose family has given informed and written consent to the patient's participation in the study

Exclusion Criteria:

• Pregnant woman,

• Patients with peripheral nerve damage prior to or at the time of measurement

• Curarized patients (non-efficacy of neurostimulation)

• Presence of a catheter in the stimulation zone (femoral artery or vein)

• Patients with lower limb, pelvic or spine fracture

• Patients with continuous renal replacement therapy

• Patients with circulatory assistance

• Patients with wounds in electrodes placement area

• Morbidly obesity with Ideal Body Weight > 40kg/m2

• Patients with pacemaker

• Lower limb deep vein thrombosis without treatment

Related Conditions & MeSH terms

• Muscle Weakness
• Paresis

Intervention

Device:
• FES cycling
On the patient, three pairs of electrodes will be applied on tibial hamstring, quadriceps and gluteal muscles of each lower limb. Cycloergometer will be installed in passive mode. Then, optimal stimulation intensity for each muscle will be defined. During twenty minutes, neuromuscular electrical stimulation will generate a passive pedaling on cycloergometer.

Locations

Country	Name	City	State
France	Chu Saint-Etienne	Saint-Étienne

Sponsors (2)

Lead Sponsor	Collaborator
Centre Hospitalier Universitaire de Saint Etienne	Laboratoire de Physique ENS de Lyon

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Tolerance	Number of FES Cycling sessions that must be stopped because of the presence of at least 1 following criteria (these criteria are qualitative (presence or absence) and therefore do not add up): Mean arterial pressure <65mmHg or> 120mmHg,; Systolic blood pressure <90 mmHg or> 200 mmHg,; Heart rate <50 or> 130 / min; Occurrence of atrial or ventricular arrhythmia; Respiratory rate > 35 / min,; Pulse oxygen saturation <90%; Intracranial pressure > 20mmHg.; Mean mean arterial velocity measured by transcranial Doppler <30 cm / s	During the FES Cycling session (day 1)
Secondary	Systolic blood pressure	Haemodynamic repercussions of a FES Cycling session measured by Systolic blood pressure	During the FES Cycling session (day 1)
Secondary	Haemodynamic tolerance Heart rate	Haemodynamic repercussions of a FES Cycling session measured by Heart rate	During the FES Cycling session (day 1)
Secondary	Cardiac output measured	Haemodynamic repercussions of a FES Cycling session measured by Cardiac output measured in transthoracic echocardiography	During the FES Cycling session (day 1)
Secondary	Fick equation	Haemodynamic repercussions of a FES Cycling session measured by oxygen consumption according to the Fick equation (cardiac output x (arterial content in O2 - venous content in O2))	During the FES Cycling session (day 1)
Secondary	Arterial lactates	Haemodynamic repercussions of a FES Cycling session measured Arterial lactates	During the FES Cycling session (day 1)
Secondary	Venous oxygen	Haemodynamic repercussions of a FES Cycling session measured by Venous oxygen saturation	During the FES Cycling session (day 1)
Secondary	Amine dosage	Haemodynamic repercussions of a FES Cycling session measured by Amine dosage	During the FES Cycling session (day 1)
Secondary	Respiratory tolerance Oxygen saturation	Respiratory repercussions of a FES Cycling session measured by Oxygen saturation	During the FES Cycling session (day 1)
Secondary	Respiratory tolerance	Respiratory repercussions of a FES Cycling session measured by Respiratory rate	During the FES Cycling session (day 1)
Secondary	Respiratory rate	Respiratory repercussions of a FES Cycling session measured by PaCO2 and PaO2	During the FES Cycling session (day 1)
Secondary	Diastolic cerebral artery	Neurological repercussions of a FES Cycling session measured by diastolic average cerebral artery measured by transcranial Doppler	During the FES Cycling session (day 1)
Secondary	Pulsatility index	Neurological repercussions of a FES Cycling session measured by Average of pulsatility index, measured by transcranial Doppler.	During the FES Cycling session (day 1)
Secondary	Intracranial pression	Neurological repercussions of a FES Cycling session measured by, If sensors present, Intracranial pression.	During the FES Cycling session (day 1)
Secondary	Cerebral perfusion pressure	Neurological repercussions of a FES Cycling session measured by, If sensors present, Cerebral perfusion pressure.	During the FES Cycling session (day 1)
Secondary	Cerebral tissue oxygen pressure	Neurological repercussions of a FES Cycling session measured by, If sensors present, Cerebral tissue oxygen pressure.	During the FES Cycling session (day 1)
Secondary	FES cycling installation	FES Cycling technical feasibility measured by installation and uninstallation times Cycloergometer,	After the FES Cycling session (day 1)
Secondary	FES Cycling technical feasibility	FES Cycling technical feasibility measured by number of persons needed.	After the FES Cycling session (day 1)
Secondary	Duration of FES Cycling session	FES Cycling technical feasibility measured by total duration of FES Cycling session.	After the FES Cycling session (day 1)
Secondary	Failure FES Cycling session	FES Cycling technical feasibility measured by number of procedural failures.	After the FES Cycling session (day 1)