Estimulação diafragmática elétrica transcutânea (EDET) para fortalecimento muscular respiratório: estudo clínico controlado e randomizado

Effects of transcutaneous electrical diaphragmatic stimulation in critically ill elderly patients: a randomized controlled trial

BACKGROUND

Elderly patients under invasive mechanical ventilation (IMV) are more susceptible to muscle weakness. In the out-of-hospital environment, there are benefits to transcutaneous electrical diaphragmatic stimulation (TEDS), which is an easy-to-apply and low-cost technique.

OBJECTIVE

To evaluate the effect of TEDS on respiratory muscle strength, diaphragm thickness (DT), and IMV time in critically ill elderly patients.

METHODS

This was a randomized controlled trial in which patients were divided into an experimental group (EG) and a control group (CG). TEDS started 24 h after orotracheal intubation and lasted until the end of weaning. Both groups underwent the following assessments during the spontaneous breathing test after weaning from mechanical ventilation (MV): measurement of respiratory muscle strength by pressure gauge, analysis of DT by lung ultrasound, and extubation failure prevention checklist.

RESULTS

There were 23 participants in the EG and 21 in the CG. The median age was 66 (60-79) years. The mean values of the diaphragmatic thickening index in the EG and CG participants were 99.13 ± 26.75 and 66.88 ± 31.77, respectively (p = .001, Cohen's d = 1.094). The mean values of maximum inspiratory pressure in the EG and CG were 22.04 ± 3.41 and 19.34 ± 4.23 cmH2O, respectively (p = .005, Cohen's d = 0.698). The Tobin index and the integrative weaning index were similar between groups (p = .584 and p = .102, respectively). The duration of MV in the EG and CG was 6.28 ± 2.68 and 9.21 ± 2.76 days, respectively (p = .001, Cohen's d = -1.075).

CONCLUSION

Critically ill elderly patients receiving TEDS had shorter MV time, greater inspiratory muscle strength, and greater diaphragmatic contraction capacity according to their thickness fraction.

Immediate Hemodynamic Responses to Transcutaneous Electrical Diaphragmatic Stimulation in Critically Ill Elderly Patients

Background

Critically ill patients admitted to intensive care units (ICUs) may develop diaphragmatic dysfunction, especially when artificial airways are used. Positive effects have been observed when using the transcutaneous electrical diaphragmatic stimulation (TEDS) technique in different clinical conditions. However, no study has evaluated the safety of TEDS in patients admitted to ICUs. This study is aimed at evaluating the influence of TEDS on the hemodynamic and vital parameters of critically ill elderly patients under invasive mechanical ventilation (IMV).

Methods

Forty-seven patients aged >60 years under IMV were evaluated for hemodynamic variables before and after TEDS. The procedure lasted 30 minutes and was performed once.

Results

The sample consisted of 33 men and 14 women with a mean age of 69.9 ± 7.64 years. The mean systolic blood pressures pre-TEDS and post-TEDS were 126.6 ± 23.7 and 122.9 ± 25.9, respectively (p = 0.467). The mean diastolic blood pressures pre-TEDS and post-TEDS were 71.1 ± 12.2 and 67.7 ± 14.2, respectively (p = 0.223). No significant differences in the mean arterial pressure or heart rate were found between the pre-TEDS and post-TEDS time points (p = 0.335 and p = 0.846, respectively).

Conclusion

Our findings suggest that TEDS does not have clinically relevant impacts on hemodynamic or vital parameters in critically ill elderly patients. These findings point to the possible safety of TEDS application in this population.

Effects of Neuromuscular Electrical Stimulation of the Quadriceps and Diaphragm in Critically Ill Patients: A Pilot Study

Background

Deep and respiratory muscle disorders are commonly observed in critically ill patients. Neuromuscular electrical stimulation (NMES) is an alternative to mobilize and to exercise that does not require active patient participation and can be used on bedridden patients.

Objective

Evaluate the effectiveness of the NMES therapy in quadriceps versus diaphragm subjects in mechanical ventilation (MV).

Methods

Sixty-seven subjects in MV were included, divided into 3 groups: (a) control group (CG, n=26), (b) stimulation of quadriceps (quadriceps group–QG, n=24), and (c) stimulation of diaphragm (diaphragm group–DG, n=17). The QG and DG patients received consecutive daily electrical stimulation sessions at specific points from the first day of randomization until ICU discharge. Respiratory and peripheral muscle strength, MV time, length of hospitalization, and functional independence score (the Functional Status Score-ICU) were recorded.

Results

There were studied n=24 (QG), n=17 (DG), and n=26 (CG) patients. Peripheral muscle strength improved significantly in the QG (p=0.030). Functional independence at ICU discharge was significantly better in QG (p=0.013), and the QG presented a better Barthel Index compared to DG and CG (p=0.0049) and also presented better FSS compared to CG (p=0.001).

Conclusions

Electrical stimulation of quadriceps had best outcomes for peripheral muscle strength compared with controls or electrical stimulation of diaphragm among mechanically ventilated critically ill subjects and promoted functional independence and decreased length of hospitalization.

Estimulação elétrica transcutânea diafragmática pela corrente russa em portadores de DPOC

RESUMO A doença pulmonar obstrutiva crônica (DPOC) ocasiona prejuízos na mecânica pulmonar, interferindo na atuação, mobilidade e conformidade do diafragma. A estimulação elétrica diafragmática tradicional é capaz de gerar benefícios ao pneumopata; poderia a corrente russa ser outra opção? Objetivou-se identificar as alterações após estimulação diafragmática elétrica transcutânea pela corrente russa em indivíduos portadores de DPOC. Trata-se de estudo prospectivo, quase experimental, com os seguintes critérios de inclusão: estabilidade medicamentosa, cessação tabágica, DPOC grau III e IV e manutenção do estilo de vida. Foram avaliadas medidas antropométricas, respiratórias e funcionais. A estimulação diafragmática se deu pelo Endophasys R ET 9701 por quatro meses, duas vezes por semana, com 30 sessões. O tempo de terapia e frequência para cada sessão foram: 18 min. (20 a 30 Hz) e 12 min. (70 a 100 Hz), respectivamente. Para análise dos dados foi aplicado teste “t” de Student (p<0,05). Participaram do tratamento 13 DPOC, sendo 11 (84,6%) do sexo masculino, todos brancos com idade de 68,46±11,11 anos e carga tabágica de 74,03±56,2 maços-ano. Ao final da intervenção houve mudanças no: volume minuto de 14,47±4,72 para 13,03±4,00 L/min.; índice BODE de 3,92±2,10 para 3,23±1,87; e distância no teste de caminhada de 6 minutos (TC6) de 336±76,36 para 402,76±51,29 m. Concluiu-se que a estimulação elétrica diafragmática por meio da corrente russa promove benefícios significativos ao portador de DPOC, proporcionando melhora respiratória e funcional.