For our Wound Research Voices feature in May, we are pleased to share a short summary of a PhD thesis by Miriam Viviane Baron. The thesis was developed at Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) in Porto Alegre, Rio Grande do Sul, Brazil. The title of the study is Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomised controlled trial.

Abstract

Exploring a new approach to pressure injury prevention in intensive care 

During my doctoral research, I wanted to address a question that sits at the intersection of wound care, rehabilitation and critical care: could neuromuscular electrical stimulation (NMES) help prevent pressure injuries in critically ill patients? 

Pressure injuries remain a major challenge in intensive care. Patients are often deeply sedated, immobile and haemodynamically unstable, which places them at very high risk. At the same time, they rapidly lose muscle mass and strength. Although repositioning and pressure-redistributing surfaces are essential parts of prevention, these measures are not always enough, particularly in the most unstable patients. This led me to explore whether NMES could offer an additional option. 

My main study, a randomised controlled trial conducted in two ICUs in Brazil, examined whether NMES added to standard care could reduce sacral pressure injuries. The results were very encouraging. Pressure injuries occurred in 35.6% of patients receiving standard care, compared with only 5.3% of those receiving NMES. We also found that the intervention was safe and associated with a shorter ICU stay. 

For me, these findings show the potential of NMES as a complementary prevention strategy for patients who cannot actively participate in mobilisation or rehabilitation. The work has also opened new paths for future research, including a multicentre trial in Brazil, postdoctoral work in Portugal, and the development of new technologies for earlier pressure injury detection. 

List of publications:

• Baron MV, Silva PE, Koepp J, Urbanetto JS, Santamaria AFM, Dos Santos MP, de Mello Pinto MV, Brandenburg C, Reinheimer IC, Carvalho S, Wagner MB, Miliou T, Poli-de-Figueiredo CE, Pinheiro da Costa BE. Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial. Ann Intensive Care. 2022 Jun 13;12(1):53. doi: 10.1186/s13613-022-01029-1. PMID: 35695996; PMCID: PMC9188909.

• Baron MV, Hernandes Martins PR, Brandenburg C, Koepp J, Reinheimer IC, Dos Santos AC, Dos Santos MP, Mantilla Santamaria AF, Miliou T, da Costa BEP. Accuracy of Thermographic Imaging in the Early Detection of Pressure Injury: A Systematic Review. Adv Skin Wound Care. 2023 Mar 1;36(3):158-167. doi: 10.1097/01.ASW.0000912000.25892.3f. PMID: 36812081.

• Baron, Miriam Viviane MSca,b,∗; Santos, Amanda Corrêa dos Medical Studentc; Martins, Paulo Ricardo Hernandes Medical Studentc; Dominguez, Luis Manuel Ley Medical Studentd; Ott, Joice Nedel MS, PhDa; Brandenburg, Cristine PhDe; Pinto, Marcus Vinicius de Mello PhDf; Sampaio, Aline Ronis Specialistf; Koepp, Janine PhDg; Pinheiro, Carolina Gonçalves Specialisth; Iketani, Nathália Ken Pereira Specialisti; Florentino, Danielle de Mello MScj; Sancho, Alexandre Gomes MSck; Pacheco, Esteban Fortuny Specialistl; Costa, Bartira Ercília Pinheiro da PhDa. The combined use of thermography and ultrasound to evaluate the development of pressure injury in a critically ill patient: Case report. Medicine Case Reports and Study Protocols 2(10):p e0157, October 2021. | DOI: 10.1097/MD9.0000000000000157