ABSTRACT
Resumen: El diafragma es una estructura músculo-aponeurótica que separa las cavidades pleural y peritoneal y provee la principal fuerza mecánica a la ventilación. Del grupo de músculos respiratorios, este es el que mayor participación tiene en lograr el retiro de la ventilación mecánica; sin embargo, también la falta de integridad del mismo en cuanto a su trofismo, nutrición y conducción puede convertirse en el mayor de los problemas para el destete. En este estudio llevamos a cabo la electroestimulación no invasiva del músculo diafragma para mejorar la conducción, así como atender su atrofia o hipotrofia, la cual es condicionada por múltiples factores, entre los que destacan fármacos, sepsis y ventilación mecánica per se. En la unidad de terapia intensiva de la nueva torre quirúrgica del Hospital General de México, se realizó el estudio de tipo experimental, prospectivo, transversal y analítico, en una población de 23 pacientes (n = 23), correspondientes a un grupo etario entre 19 y 75 años de edad, con una media de 40 años, divididos en tres grupos: A, B, C, donde a los del grupo «A¼ se les aplicó terapia de electroestimulación del músculo diafragma, dos sesiones al día de 15 minutos cada una; en el grupo «B¼, tres sesiones al día de 15 minutos cada una, y en el grupo «C¼, cuatro sesiones al día de 15 minutos cada una. Cada impulso del electroestimulador fue de una intensidad de 10 hasta 300 mA, lo que se determinó con base en el grado de tolerancia del paciente, el cual se encontraba despierto, con RASS de 0 a -1 y cooperador, aun con tubo endotraqueal, pero que cumplió con todas las condiciones previamente para iniciar el retiro de la ventilación mecánica. Para la ubicación de los electrodos, nos basamos en los puntos de inserción anteriores y laterales para músculo diafragma, número de electrodos empleados (cuatro); previo a la electroestimulación, se tomó en cuenta la presión soporte inicial, así como el volumen corriente inspirado y el grosor del músculo diafragma, el cual se verificó con visión directa en apoyo con ultrasonido. Al final de la terapia, se tomaron en cuenta las mismas variables para observar diferencias. Se obtuvieron resultados con una p significativa de 0.048 para el aumento del grosor del músculo diafragma a tres días en el grupo C (cuatro sesiones al día), con un intervalo de confianza de 95% en su límite inferior de 0.01 y límite superior de 1.65. Pero los resultados al observar la diferencia entre grupos en cuanto a la disminución de la presión soporte fueron aún más significativos (p < 0.05) para este mismo grupo a tres días de la terapia.
Abstract: The diaphragm is a muscle-aponeurotic structure, which separates the pleural and peritoneal cavities and provides the main force of mechanical ventilation. Among the group of respiratory muscles, this has the greater participation in achieving the withdrawal of mechanical ventilation; however, the lack of integrity in its trophism, nutrition and driving, can also become the greatest problems for weaning. In this study we conducted the non-invasive electro-stimulation of the diaphragm muscle to improve conduction, as well as to treat its atrophy or hypotrophy, which is conditioned by various factors, including drugs, sepsis, and mechanical ventilation per se. In the intensive therapy unit of the new surgical tower of the Hospital General de Mexico, we carried out this experimental, prospective, and cross-analytical study in a population of 23 patients (n = 23) aged between 19 and 75 years, with an average of 40 years, divided into three groups: A, B, and C; group «A¼ received electro-muscle stimulation of the diaphragm two 15-minute sessions per day; group «B¼, three 15- minute sessions per day, and group «C¼, four 15-minute sessions per day. Each impulse of the electro-stimulator had an intensity of 10 to 300 mA that was determined based on the grade of tolerance of the patient, who was awake, with RASS of 0 to-1 and cooperative, even with the endotracheal tube, but that had previously met all the conditions to start the removal of the mechanical ventilation. We based the location of the electrodes on the anterior and lateral points of inclusion for diaphragm muscle, number of electrodes used (four): prior to the electro-stimulation, we considered the initial pressure support, as well as the inspired tidal volume and the thickness of the diaphragm muscle, which was verified with direct vision supported by ultrasound. At the end of the therapy, the same variables were taken into account for observed differences. We obtained results with a p significant of 0.048 for the increase of the thickness of the diaphragm muscle in three days in group C (four sessions per day), with a range of confidence of 95% in its lower limit of 0.01 and upper limit of 1.65. However, the results when observing the difference between groups with regard to the decrease of the pressure support were even more significant (p < 0.05) for this same group after three days of therapy.
Resumo: O diafragma é uma estrutura músculo-aponeurótica que separa as cavidades pleural e peritoneal e fornece a principal força mecânica para a ventilação. Entre o grupo de músculos respiratórios, este é o que tem maior participação na retirada da ventilação mecânica; no entanto, a falta de integridade do mesmo em quanto ao seu trofismo, nutrição e condução, podem se tornar os maiores problemas para o desmame. Neste estudo realizamos a eletroestimulação não-invasiva do músculo diafragma para melhorar a condução, bem como para tratar sua atrofia ou hipotrofia, que é condicionada por vários fatores, incluindo medicamentos, sepsis e ventilação mecânica per se. Na unidade de terapia intensiva da nova torre cirúrgica do Hospital General de México, realizamos este estudo experimental, prospectivo, transversal e analítico, em uma população de 23 pacientes (n = 23) com idade entre 19 e 75 anos, com uma média de 40 anos, divididos em três grupos: A, B e C; grupo «A¼ recebeu terapia de eletroestimulação do músculo diafragma, duas sessões por dia de 15 minutos cada uma; grupo «B¼, três sessões por dia de 15 minutos cada uma e grupo «C¼, quatro sessões por dia de 15 minutos cada uma. Cada impulso do eletroestimulador teve uma intensidade de 10 à 300 mA, que foi determinado com base no grau de tolerância do paciente, quem estava acordado, com RASS de 0 a -1 e cooperativo, mesmo com o tubo endotraqueal, mas que preenchia todas as condições prévias para iniciar a remoção da ventilação mecânica. Para a localização dos eletrodos determinamos os pontos de inserção anteriores e laterais do músculo diafragma, número de eletrodos usados (quatro); antes da eletroestimulação, consideramos a pressão suporte inicial, o volume corrente inspirado e a espessura do músculo, que foi verificado com visão direta por ultra-som. No final da terapia, as mesmas variáveis foram consideradas para observar as diferenças. Obtivemos resultados com uma p significativa de 0.048 para o aumento da espessura do músculo diafragma em três dias no grupo C (quatro sessões por dia), com um intervalo de confiança de 95% no seu limite inferior de 0.01 e limite superior de 1.65. No entanto, os resultados ao observar a diferença entre os grupos em relação à a diminuição da pressão suporte foram ainda mais significativas (p <0.05) para este mesmo grupo após três dias de terapia.
ABSTRACT
Objective To investigate the effect of diaphragm training on respiratory function and the activities of daily living after cerebral apoplexy.Methods Seventy-eight patients with post-stroke fatigue were randomly divided into a treatment group and a routine therapy group,each of 39.Both groups were given conventional rehabilitation treatment,while the treatment group was additionally provided with diaphragm muscle training.Before and after 4 weeks of treatment,both groups were evaluated using pulmonary function tests,a fatigue severity scale (FSS),Fugl-Meyer motor function assessment (FMA) and the modified Barthel index (MBI).Results Vital capacity,forced vital capacity,forced vital capacity during the first second,and especially the maximum ventilatory volume of the treatment group were all significantly improved after the treatment.There was also significant improvement in that group's average FSS score,but not in that of the control group.The average FMA and MBI scores for both groups had improved significantly after the intervention,with the average FMA score of the treatment group significantly higher than that of the control group.However,no significant differences in the average MBI score were observed after the treatment.Conclusion Diaphragm training can significantly improve motor function and the daily life of stroke survivors.The mechanism may be related to improved respiratory function and decreased severity of fatigue.
ABSTRACT
Background: the impact of human immunodeficiency virus type 1 (HIV-1) on lung function is well known and associated with a reduction in pulmonary ventilation. Moreover, the use of highly active antiretroviral therapy has been associated with mitochondrial dysfunction and decreased muscle strength. However, there is scarce information about the factors associated with inspiratory muscle weakness in these patients. Objective: the purpose of the present study was to investigate the factors associated with inspiratory muscle weakness in patients with HIV-1. Methods: two-hundred fifty seven patients with HIV-1 were screened and categorized into two groups: (1) IMW+ (n = 142) and (2) IMW-(n = 115). Lung function (FEV1, FVC and FEV1 /FVC), maximum inspiratory pressure, distance on the six-minute walk test and CD4 cell count were assessed. Results: the mean duration of HIV infection was similar in the two groups. The following variables were significantly different between groups: mean duration of highly active antiretroviral therapy (81 ± 12 in IMW+ versus 38 ± 13 months in IMW-; p = 0.01), and CD4 cell count (327 ± 88 in IMW+ versus 637 ± 97 cells/mm3 in IMW-; p = 0.02). IMW+ presented reduced lung function (FEV1, FVC, FEV1/FVC). Conclusion: patients with IMW+ had lower distance on the six-minute walk test in comparison to the IMW- group. The duration of highly active antiretroviral therapy, distance traveled on the 6MWT and CD4 count were determinants of IMW in patients with HIV. .
Subject(s)
Female , Humans , Male , Middle Aged , Anti-HIV Agents/therapeutic use , HIV Infections/physiopathology , Muscle Weakness/physiopathology , Respiratory Muscles/physiopathology , Anti-HIV Agents/adverse effects , Exercise Test , HIV Infections/drug therapy , HIV-1 , Random Allocation , Respiratory Function Tests , Risk Factors , Time Factors , Viral LoadABSTRACT
Objective To investigate the effect of chronic low-frequency electrical stimulation on the structural and metabolic changes of diaphragm of emphysema rabbits.Methods The rabbit model of emphysema was made by papain-inhaling of ultrasonic atomization once a week for 3 weeks in 30 adult Japanese rabbits,6 receiving 10 Hz chronic low frequency electrical stimulation,6 receiving 40 Hz,and 6 receiving(10+40)Hz.Other 6 emphysema rabbits and 6 normal rabbits served as control.An enzyme chemical method was used to observe the changes in the enzyme activities of sarcoplasmic reticulum Ca2+-ATPase,succinate dehydrogenase(SDH)and the lactate dehydrogenase(LDH)and changes in MHC in control group,emphysema group,and emphysema+chronic low frequency electrical stimulation group.Results Following chronic electrical stimulation using 40 Hz,10 Hz,and(10+40)Hz,the relative contents of MHC were increased in the diaphragmatic muscle of rabbits with emphysema.The percentage of MHC-Ⅰ was significantly increased in the 10 Hz group,while that of MHC-Ⅱa was significantly increased in the(10+40)Hz group.Following chronic electrical stimulation using 40 Hz and(10+40)Hz,diaphragmatic muscle SR Ca2+-ATPase activity was increased in rabbits with emphysema(P
ABSTRACT
Objective To investigate the effect of chronic electrical stimulus (CES) of low frequency and physiological frequency on diaphragmatic subtype of myosin heavy chain (MHC) and mechanical characteristic in rabbits with emphysema. Methods The rabbit model of emphysema was made by inhaling papain of ultrasonic atomization once a week for 3 weeks in 30 adult Japanese rabbits, 6 receiving 10 Hz chronic low-frequency electrical stimulation, 6 receiving 40 Hz, 6 receiving 10 Hz plus 40 Hz. Another 6 emphysema rabbits and 6 normal rabbits served as control. The twitch tension (Pt), titanic tension (Po), time to peak tension (TPT), half-relaxation time (1/2Rt), fatigue index (FI) and fatigue recovery index (FRI) were measured and SDS-polyacrylamide gel electrophoresis was used to observe the changes in subtype of MHC in control group, emphysema group, CES groups respectively. Results ①Following chronic electrical stimulus of 40 Hz, 10 Hz, and (10+40) Hz, the relative contents of MHC were increased in diaphragmatic muscle of rabbits with emphysema. The percentage of MHC-I was significantly increased in the 10 Hz group, while that of MHC-I and MHC-IIa were significantly increased in the (10+40) Hz group. ②Following chronic electrical stimulation using 40 Hz and (10+40)Hz, diaphragmatic muscle Pt and Po were significantly increased in rabbits with emphysema, TPT and 1/2Rt were significantly reduced, and FI and FRI were significantly decreased (P
ABSTRACT
Objective To investigate the effect of chronic ultra-low frequency electrical stimulation on mechanical characteristic of diaphragmatic muscle of emphysema rabbit.Methods The rabbit model of emphysema was made by inhaling papain of ultrasonic atomization once a week for 3 weeks in 24 adult Japanese rabbits,6 receiving 10 Hz chronic ultra-low frequency electrical stimulation,6 receiving 40 Hz,6 receiving 2.5 Hz and 40 Hz.Another 6 rabbits served as control.The twitch tension (Pt),titanic tension(Po),time to peak tension(TPT),half-relaxation time(1/2RT),fatigue index(FI) and fatigue recovery index(FRI) were measured in control group,emphysema group,emphysema+chronic ultra-low frequency electrical stimulation groups.Results As compared with the control rabbits, Pt and Po decreased,TPT and 1/2RT prolonged,FI and FRI increased in the only emphysema rabbits.Pt and Po were higher,TPR and 1/2Rt was shorter in the only emphysema rabbits than the rabbits in 40 Hz and(2.5+40) Hz groups(P0.05),more increase in FR and FRI(P