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Ann Intensive Care. 2016 Dec;6(1):21. doi: 10.1186/s13613-016-0123-y. Epub 2016 Mar 11.

Neuromuscular electrical stimulation acutely mobilizes endothelial progenitor cells in critically ill patients with sepsis.

Author information

1
1st Critical Care Department, Evangelismos General Hospital, School of Medicine, National and Kapodistrian University of Athens, 45-47 Ypsilantou Str., 106 75, Athens, Greece.
2
Immunology and Histocompatibility Department, Evangelismos General Hospital, 45-47 Ypsilantou Str, 106 75, Athens, Greece.
3
Critical Care Unit, Guys and St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
4
2nd Neurosurgical Department, Attiko University General Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str, 124 62, Athens, Greece.
5
1st Critical Care Department, Evangelismos General Hospital, School of Medicine, National and Kapodistrian University of Athens, 45-47 Ypsilantou Str., 106 75, Athens, Greece. a.icusn@gmail.com.

Abstract

BACKGROUND:

Endothelial progenitor cells (EPCs) have been suggested to constitute a restoration index of the disturbed endothelium in ICU patients. Neuromuscular electric stimulation (NMES) is increasingly employed in ICU to prevent comorbidities such as ICU-acquired weakness, which is related to endothelial dysfunction. The role of NMES to mobilize EPCs has not been investigated yet. The purpose of this study was to explore the NMES-induced effects on mobilization of EPCs in septic ICU patients.

METHODS:

Thirty-two septic mechanically ventilated patients (mean ± SD, age 58 ± 14 years) were randomized to one of the two 30-min NMES protocols of different characteristics: a high-frequency (75 Hz, 6 s on-21 s off) or a medium-frequency (45 Hz, 5 s on-12 s off) protocol both applied at maximally tolerated intensity. Blood was sampled before and immediately after the NMES sessions. Different EPCs subpopulations were quantified by cytometry markers CD34(+)/CD133(+)/CD45(-), CD34(+)/CD133(+)/CD45(-)/VEGFR2 (+) and CD34(+)/CD45(-)/VEGFR2 (+).

RESULTS:

Overall, CD34(+)/CD133(+)/CD45(-) EPCs increased from 13.5 ± 10.2 to 20.8 ± 16.9 and CD34(+)/CD133(+)/CD45(-)/VEGFR2 (+) EPCs from 3.8 ± 5.2 to 6.4 ± 8.5 cells/10(6) enucleated cells (mean ± SD, p < 0.05). CD34(+)/CD45(-)/VEGFR2 (+) EPCs also increased from 16.5 ± 14.5 to 23.8 ± 19.2 cells/10(6) enucleated cells (mean ± SD, p < 0.05). EPCs mobilization was not affected by NMES protocol and sepsis severity (p > 0.05), while it was related to corticosteroids administration (p < 0.05).

CONCLUSIONS:

NMES acutely mobilized endothelial progenitor cells, measures of the endothelial restoration potential, in septic ICU patients.

KEYWORDS:

Acute effect; Critical illness; EPC; Early rehabilitation; Electrical muscle stimulation; NMES

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