ABSTRACT
Resumen: Introducción: La atrofia y disfunción del músculo diafragmático es frecuente en pacientes sometidos a ventilación mecánica. La terapia de electroestimulación diafragmática transcutánea (TEDT) ha demostrado mejorar la fuerza en pacientes con debilidad muscular; sin embargo, no ha sido evaluada como tratamiento para la atrofia en la disfunción diafragmática inducida por ventilación mecánica (DDIVM). Objetivo: Determinar si la TEDT puede mejorar el grosor diafragmático de los pacientes que se encuentran bajo ventilación mecánica. Material y métodos: Se realizó un ensayo clínico aleatorizado en dos grupos independientes: un grupo intervención con 15 pacientes y un grupo control con 17 pacientes. El grupo de intervención recibió TEDT con sesiones de 20 minutos cada seis horas en las 72 horas subsecuentes a su inclusión al estudio. El grosor diafragmático basal fue medido mediante ecografía en ambos grupos, después de la TEDT para el grupo intervención y 72 horas después en el grupo control. Resultados: De los 32 pacientes evaluados se documentó una media de grosor diafragmático inicial para el grupo control de 2.04 ± 0.43 mm y de 1.9 ± 0.52 mm para el grupo intervención con un valor de p = 0.652. Posterior a la intervención, se registró una media de grosor diafragmático final de 1.7 ± 0.43 mm para el grupo control y 2.3 ± 0.55 mm para el grupo intervención con un valor de p = 0.002 al comparar ambos grupos. Conclusión: Se encontró diferencia estadísticamente significativa en ambos grupos al aplicar la TEDT, evidenciando un aumento del grosor diafragmático basal en el grupo intervención y disminución del mismo en el grupo control.
Abstract: Introduction: Muscle involvement in critically ill patients is present in the majority of those admitted to the intensive care unit, including alteration of the diaphragmatic muscle, especially during mechanical ventilation (MV). Transcutaneous diaphragmatic electrostimulation therapy (TEDT) has been shown to improve respiratory strength in patients with muscle weakness. However, it has not been evaluated as a treatment for atrophy in Ventilation-Induced Diaphragmatic Dysfunction (DDIVM). Objective: To determine if TEDT can improve diaphragmatic thickness in patients undergoing mechanical ventilation. Material and methods: A randomized clinical trial was carried out in two independent groups: an intervention group with 15 patients and a control group with 17 patients. The intervention group received TEDT with sessions of 20 minutes every 6 hours in the 72 hours after their inclusion in the study. Baseline diaphragm thickness was measured by ultrasound in both groups, after TEDT for the intervention group and 72 hours later in the control group. Results: Of the 32 patients evaluated, a mean initial diaphragmatic thickness was documented for the control group of 2.04 ± 0.43 mm and of 1.9 ± 0.52 mm for the intervention group with a p value of 0.652. After the intervention, a mean final diaphragmatic thickness of 1.7 ± 0.43 mm was recorded for the control group and 2.3 ± 0.55 mm for the intervention group with a p value of 0.002 when comparing both groups. Conclusion: A statistically significant difference was found in both groups when applying TEDT, showing an increase in baseline diaphragmatic thickness in the intervention group and a decrease in it in the control group.
Resumo: Introdução: Atrofia e disfunção do músculo diafragmático é comum em pacientes submetidos à ventilação mecânica. A terapia de estimulação elétrica diafragmática transcutânea (TEDT) demonstrou melhorar a força em pacientes com debilidade muscular, mas não foi avaliada como tratamento para atrofia na disfunção diafragmática induzida pela ventilação (DDIVM). Objetivo: Determinar se a TEDT pode melhorar a espessura diafragmática de pacientes com ventilação mecânica. Material e métodos: Realizou-se um ensaio clínico randomizado em 2 grupos independentes: um grupo intervenção com 15 pacientes e um grupo controle com 17 pacientes. O grupo intervenção recebeu TEDT com sessões de 20 minutos a cada 6 horas por 72 horas após a inclusão no estudo. A espessura diafragmática basal foi medida por ultra-som em ambos os grupos, após TEDT para o grupo de intervenção e 72 horas depois no grupo controle. Resultados: Dos 32 pacientes avaliados, (17 grupo controle, 15 grupo intervenção). Documentou-se uma média da espessura diafragmática basal para o grupo controle de 2.04 ± 0.43 mm e 1.9 ± 0.52 mm para o grupo intervenção com um valor de p = 0.652. Após a intervenção, foi registrada uma espessura média final do diafragma de 1.7 ± 0.43 mm para o grupo controle e 2.3 ± 0.55 mm para o grupo intervenção, com valor de p = 0.002 na comparação entre os dois grupos. Conclusão: Encontrou-se diferença estatisticamente significativa em ambos os grupos na aplicação do TEDT, mostrando aumento da espessura basal do diafragma no grupo intervenção e diminuição da mesma no grupo controle.
ABSTRACT
Objective To investigate the effects of propofol combined with nalbuphine on diaphragmatic movement monitored by ultrasound in patients undergoing colonoscopy.Methods Forty patients, males 21 and females 19, aged 18-65 years, BMI 18-25 kg/m2, ASA physical status I or II, were recruited and scheduled to undergo elective painless colonoscopy.All patients were randomly divided into two groups (n =20):propofol group (group P) and propofol combined with nalbuphine group (group F).Patients in group F received nalbuphine 0.1 mg/kg intravenously 1 min before propofol administration, and patients in group P received same volume of normal saline.Propofol was infused by TCI and the initial target plasma concentration was set at 2μg/ml in all patients.The target concentration was adjusted gradually until the Ramsay sedation score reached 5.Then colonoscopy was started.During the colonoscopy, the propofol concentration was adjusted according to the Ramsay score.Ultrasound was used to monitor the movement of the right diaphragm of the patients.SpO2, MAP, HR, PETCO2, RR, diaphragmatic movement (DM), diaphragmatic thickness at the end of inspiration (TEI) and diaphragmatic thickness at the end of expiration (TEE) were recorded under calm breathing after entering the room (T0), Ramsay sedation score 5 points after propofol administration (T1), and Ramsay sedation score 2 after endoscopy (T2).The diaphragmatic thickening fraction (DTF) was calculated:DTF= (TEI-TEE) /TEI.Adverse reactions such as bradycardia, hypotension, body movement, and respiratory depression were recorded.Results Compared with T0, MAP, SpO2, HR and RR decreased, and PETCO2 increased at T1 time point in patients of the two groups (P<0.05).Compared with group F, the dose of propofol increased in group P (P<0.05).DM at T1 and T2, DTF at T1 were obviously higher in group F than those in group P (P<0.05).There were two cases had body movement in group P, and one case had bradycardia in group F.There was no case suffered from hypotension, respiratory depression and reflux aspiration in two groups.Conclusion Compared with propofol alone, propofol combined with nalbuphine can attenuate the dysfunction of the diaphragm.