Efficacy of transcutaneous electrical nerve stimulation (Active TENS versus Sham TENS) on hemodynamic stability and renal tissue perfusion guided by NGAL test for patients with hypovolemic shock - A prospective randomized clinical study

Abstract Background: Hypovolemic shock occurs due to many causes and it has complex patho-physiology which finally leads to decreased all organs perfusion. Transcutaneous electrical nerve stimulation (TENS) consists of a generic application of low-frequency, pulsed electrical currents transmitted by electrodes through the skin surface to stimulate the primary afferent pathways (peripheral nerves) to produce various physiological effects.Objective: Was to evaluate the effect of transcutaneous electrical nerve stimulation application on the renal tissue perfusion and hemodynamic stability for patients with hypovolemic shock.Design: A prospective, single-blind, randomized, sham-controlled trial. Patients were randomized into two groups (active TENS versus sham TENS). Active TENS group received resuscitation protocol and transcutaneous electrical nerve stimulation while sham TENS group received resuscitation protocol only.Setting: Data was collected from general and obstetric ICU.Main Outcome Measures: Improvement of renal tissue perfusion was considered the primary outcome and secondary outcomes was improvement of hemodynamic parameters.Results: TENS application had caused a highly statistical significant change in serum Creatinine and NGAL test (74.43 ± 7.16 in active TENS versus 114.48 ± 13.6 2 in sham TENS) and (7.35 ± 0.7716 in active TENS versus 20.76 ± 2.11 in sham TENS) (P = 0.007 & P= 0.000) respectively. There was highly statistical significant difference before treatment and after treatment regarding urea, creatinine and NGAL test in the control group (P= 0.002 & P= 0.006& P= 0.000) respectively and there was highly statistical significant difference before treatment and after treatment in TENS group regarding to serum Creatinine (P= 0.003).Conclusion: We concluded the following; Application of TENS is extremely effective on improvement of renal tissue perfusion and and hemodynamic parameters. Also TENS should be used as a nursing intervention to maintain hemodynamic stability in patients with hypovolemic shock in the intensive care unit and we found patients with hypovolemic shock who received active TENS had better outcomes than patients who received sham TENS.