{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T08:01:09Z","timestamp":1779177669105,"version":"3.51.4"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T00:00:00Z","timestamp":1644969600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Neuromuscular electrical stimulation (NMES) can be applied to critically ill patients. However, its results on muscle strength and functionality in patients with COVID-19 are unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>Evaluate the effects of intervention with NMES on muscle mass and functionality of patients with severe COVID-19 associated with sepsis and septic shock.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seven patients with COVID-19 associated with sepsis or septic shock were selected, but only 5 patients completed all days of the intervention with NMES. The intervention was performed by a single physiotherapist on 7 consecutive days in a daily session of 40 min. The outcome measures were the femoris cross-sectional area; thickness of the anterior compartment of the quadriceps muscle; rectus femoris echogenicity; International Classification of Functioning, Disability, and Health (ICF)-muscle strength; PFIT-s, DEMMI, and the SOMS; feasibility, and safety. The patients were evaluated on days 1, 5, and 8.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The rectus femoris cross-sectional area decreased significantly from days 1 to 8, but showed maintenance of the thickness of the anterior compartment of the quadriceps muscle from days 1 to 8. The MRC score increased significantly from days 1 to 5 and kept this improvement until day 8. All patients showed an increase in the MRC score and reduction of the ICF-muscle strength, meaning improved muscle strength from days 1 to 8. The PFIT-s increased significantly from days 1 to 5 and improved until day 8 compared to day 5. DEMMI and SOMS score increased significantly on day 8 compared to days 1 and 5.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Rehabilitation with NMES showed improvement in muscle strength and functionality of patients in this study with a potential protective effect on muscle mass loss in patients with critical COVID-19 associated with sepsis and septic shock. This study is the first report of the potential effects of neuromuscular electrical stimulation in patients with severe COVID-19 associated with sepsis and septic shock.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.751636","type":"journal-article","created":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T04:37:35Z","timestamp":1644986255000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Neuromuscular Electrical Stimulation in Patients With Severe COVID-19 Associated With Sepsis and Septic Shock"],"prefix":"10.3389","volume":"9","author":[{"given":"Renato Fraga","family":"Righetti","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha Torres","family":"Grams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wesla Neves da Silva","family":"Costa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leandro Teixeira","family":"Saraiva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel Chateaubriand Diniz de","family":"Salles","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wellington Pereira","family":"Yamaguti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,16]]},"reference":[{"key":"B1","unstructured":"2020"},{"key":"B2","doi-asserted-by":"publisher","first-page":"163","DOI":"10.4081\/monaldi.2020.1285","article-title":"Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR)","volume":"90","author":"Lazzeri","year":"2020","journal-title":"Monaldi Arch Chest Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e2017","DOI":"10.6061\/clinics\/2020\/e2017","article-title":"Physiotherapy care of patients with coronavirus disease 2019. 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