Université Paris-Saclay, UVSQ, Erphan, 78000, Versailles, France.
Intensive Care Unit Department, Le Havre Hospital, Avenue Pierre Mendes France, 76290, Montivilliers, France.
Crit Care. 2023 Aug 30;27(1):338. doi: 10.1186/s13054-023-04597-1.
Few specific methods are available to reduce the risk of diaphragmatic dysfunction for patients under mechanical ventilation. The number of studies involving transcutaneous electrical stimulation of the diaphragm (TEDS) is increasing but none report results for diaphragmatic measurements, and they lack power. We hypothesised that the use of TEDS would decrease diaphragmatic dysfunction and improve respiratory muscle strength in patients in ICU.
We conducted a controlled trial to assess the impact of daily active electrical stimulation versus sham stimulation on the prevention of diaphragm dysfunction during the weaning process from mechanical ventilation. The evaluation was based on ultrasound measurements of diaphragm thickening fraction during spontaneous breathing trials. We also measured maximal inspiratory muscle pressure (MIP), peak cough flow (PEF) and extubation failure.
Sixty-six patients were included and randomised using a 1:1 ratio. The mean number of days of mechanical ventilation was 10 ± 6.8. Diaphragm thickening fraction was > 30% at the SBT for 67% of participants in the TEDS group and 54% of the Sham group (OR1.55, 95% CI 0.47-5.1; p = 0.47). MIP and PEF were similar in the TEDS and Sham groups (respectively 35.5 ± 11.9 vs 29.7 ± 11.7 cmH0; p = 0.469 and 83.2 ± 39.5 vs. 75.3 ± 34.08 L/min; p = 0.83). Rate of extubation failure was not different between groups.
TEDS did not prevent diaphragm dysfunction or improve inspiratory muscle strength in mechanically ventilated patients.
Prospectively registered on the 20th November 2019 on ClinicalTrials.gov Identifier NCT04171024.
目前用于降低机械通气患者发生膈肌功能障碍风险的特定方法较少。涉及经皮膈神经电刺激（TEDS）的研究数量正在增加，但尚无研究报告膈肌测量结果，且这些研究的效力不足。我们假设，在机械通气撤机过程中使用 TEDS 会降低膈肌功能障碍的发生率并改善呼吸肌力量。
我们进行了一项对照试验，以评估每日主动电刺激与假刺激对预防机械通气撤机过程中膈肌功能障碍的影响。评估基于自主呼吸试验中膈肌增厚分数的超声测量。我们还测量了最大吸气肌肉压力（MIP）、峰值咳嗽流量（PEF）和拔管失败。
66 名患者按 1:1 比例随机分组。机械通气天数中位数为 10 ± 6.8 天。TEDS 组有 67%的患者在 SBT 时膈肌增厚分数>30%，而 Sham 组有 54%（OR1.55，95%CI 0.47-5.1；p=0.47）。TEDS 组和 Sham 组的 MIP 和 PEF 相似（分别为 35.5 ± 11.9 与 29.7 ± 11.7 cmH0；p=0.469 和 83.2 ± 39.5 与 75.3 ± 34.08 L/min；p=0.83）。两组拔管失败率无差异。
TEDS 不能预防机械通气患者的膈肌功能障碍或改善吸气肌力量。
2019 年 11 月 20 日在 ClinicalTrials.gov 上进行了前瞻性注册，标识符为 NCT04171024。
