Evidence map›Paper›PMID 36473808›Full record

Trial reportHeart & lung : the journal of critical care

Combining exercise, protein supplementation and electric stimulation to mitigate muscle wasting and improve outcomes for survivors of critical illness-The ExPrES study.

Avelino C Verceles, Monica Serra, Derik Davis, Gad Alon, Chris L Wells, Elizabeth Parker, John Sorkin, Waqas Bhatti, Michael L Terrin

2 registry-linked trialsOpen access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Heart & lung : the journal of critical care. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 28 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 8 pooled it
5.6field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02509520 naactive not recruitingnot on this map

Rehabilitation, NMES and High Protein to Reduce Post ICU Syndrome in the Elderly

TypeinterventionalSponsorUniversity of Maryland, BaltimoreRan2015 to 2027Enrolled60ConditionsMuscle Weakness, Critical Illness, SarcopeniaArmsMPR and High Protein Supplement (HPRO) and Neuromuscular Electric Stimulation (NMES)
NCT07543016 narecruitingnot on this map

Amino Acid Supplementation and Physical Exercise in Facioscapulohumeral Muscular Dystrophy: Effects on Body Composition and Physical Efficiency in a Model of Muscular Disease

TypeinterventionalSponsorUniversity of PaviaRan2026 to 2029Enrolled48ConditionsFSH Muscular Dystrophy, Muscular DystrophyArmsEssential Amino Acids Supplementation intervention, Exercise, Diet, Placebo Control
3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 8 syntheses or guidelines pooled it, 41 citations in OpenAlex.

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  19. Sarcopenia and frailty in critical illness.Current opinion in clinical nutrition and metabolic care · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 1 country.

Avelino C VercelesDivision of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: Avercele@som.umaryland.edu.
Monica SerraDepartment of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies at University of Texas Health Science, San Antonio, TX, USA.
Derik DavisDivision of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Gad AlonDepartment of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD.
Chris L WellsDepartment of Rehabilitation Services, University of Maryland Medical Center, Baltimore, MD, USA.
Elizabeth ParkerDepartment of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD.
John SorkinDepartment of Medicine, Division of Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore MD, USA; Department of Veterans Affairs, Baltimore VA Maryland Health Care System, Geriatric Research, Education and Clinical Center, Baltimore, MD, USA.
Waqas BhattiDivision of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Michael L TerrinDivision of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
University of Maryland, Baltimore · USThe University of Texas Health Science Center at San Antonio · USVA Maryland Health Care System · US

Funding

University of Maryland Claude D. Pepper Older Americans Independence Center (UM-OAIC)P30AG028747 · NIA · UNIVERSITY OF MARYLAND BALTIMORE · PI Stephen L. Seliger · 2006 to 2026
$28.9M
Rehabilitation, NMES and High Protein to Reduce Post ICU Syndrome in the ElderlyR21AG050890 · NIA · UNIVERSITY OF MARYLAND BALTIMORE · PI VERCELES, AVELINO CATALINO · 2015 to 2016
$422k
Aerobic Training to Improve Energy Utilization and Antioxidant Capacity in StrokeIK2RX000944 · VA · VETERANS HEALTH ADMINISTRATION · PI SERRA, MONICA C · 2014 to 2019
–
NIA NIH HHS P30 AG028747NIA NIH HHS R21 AG050890RRD VA IK2 RX000944
6 · The paper itself

Abstract

backgroundNeuromuscular electrical stimulation (NMES) with high protein supplementation (HPRO) to preserve muscle mass and function has not been assessed in ICU patients. We compared the effects of combining NMES and HPRO with mobility and strength rehabilitation (NMES+HPRO+PT) to standardized ICU care.

objectivesTo assess the effectiveness of combined NMES+HPRO+PT in mitigating sarcopenia as evidenced by CT volume and cross-sectional area when compared to usual ICU care. Additionally, we assessed the effects of the combined therapy on select clinical outcomes, including nutritional status, nitrogen balance, delirium and days on mechanical ventilation.

methodsParticipants were randomized by computer generated assignments to receive either NMES+HPRO+PT or standard care. Over 14 days the standardized ICU care group (N = 23) received usual critical care and rehabilitation while the NMES+HPRO+PT group (N = 16) received 30 min neuromuscular electrical stimulation of quadriceps and dorsiflexors twice-daily for 10 days and mean 1.3 ± 0.4 g/kg body weight of high protein supplementation in addition to standard care. Nonresponsive participants received passive exercises and, once responsive, were encouraged to exercise actively. Primary outcome measures were muscle volume and cross-sectional area measured using CT-imaging. Secondary outcomes included nutritional status, nitrogen balance, delirium and days on mechanical ventilation.

resultsThe NMES+HPRO+PT group (N = 16) lost less lower extremity muscle volume compared to the standard care group (N = 23) and had larger mean combined thigh cross-sectional area. The nitrogen balance remained negative in the standard care group, while positive on days 5, 9, and 14 in the NMES+HPRO+PT group. Standard care group participants experienced more delirium than the NMES+HPRO+PT group. No differences between groups when comparing length of stay or mechanical ventilation days.

conclusionsThe combination of neuromuscular electrical stimulation, high protein supplementation and mobility and strength rehabilitation resulted in mitigation of lower extremity muscle loss and less delirium in mechanically ventilated ICU patients.

trial registrationClinicaltrials.gov identifier: NCT02509520. Registered July 28, 2015.

Indexed as

Critical IllnessDeliriumDietary SupplementsElectric StimulationHumansIntensive Care UnitsMusclesMuscle StrengthNitrogenSurvivorsNitrogenCritical care nutritionHigh protein supplementICUICU acquired weaknessMultimodal rehabilitation trainingNeuromuscular electrical stimulation

Identifiers

PMID36473808
PMCPMC9992240
OpenAlexW4312099226

What OpenQuestion holds

Textmetadata
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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.