ABSTRACT
Objective:To explore the effects of external diaphragm electrical stimulation on the diaphragm thickness and function in mechanically ventilated children.Methods:A randomized controlled trial was conducted in children who were admitted to PICU at Children′s Hospital of Fudan University and received mechanical ventilation between June 2021 and April 2022.The control group was given the routine treatment of mechanical ventilation, and the intervention group was given external diaphragm electrical stimulation in the early stage of mechanical ventilation in addition to routine treatment.Diaphragm thickness was continuously measured by bedside ultrasound every day for one week after mechanical ventilation, and the changing trend of diaphragm thickness was observed, and the diaphragmatic thickening fraction (DTf) and the incidence of ventilator-induced diaphragmtic dysfunction(VIDD) were calculated at the same time.Results:A total of 32 valid samples were included, including 15 cases in intervention group (10 males) and 17 cases in control group (11 males). The median age of the patients was 33 (10, 77) months, and the median duration of mechanical ventilation was 12 (8, 21) days.The reasons for mechanical ventilation in children included respiratory insufficiency in ten cases, brain dysfunction in ten cases, heart failure in eight cases, and postoperative surgery in four cases.The diaphragm end-expiratory thickness (DTe) in intervention group and the control group showed a gradually decreasing trend from the 1st day to the 7th day.The left thickness was reduced by 11% on the 7th day compared to 1st day in intervention group, which was reduced by 18% in control group; the average daily DTe was reduced by 2% per day in intervention group and by 3% per day in control group.The trends on the right and left were similar.The DTe thickness in the intervention group was greater than that in control group, among which, the mean DTe thickness in the left side of the intervention group on the 7th day was (0.110 7±0.023 7)cm, which was greater than that in control group (0.093 5±0.016 9)cm, and the difference was statistically significant ( t=-2.372, P<0.05); On the second day, the mean DTe thickness on the right side in the intervention group was (0.1267±0.0277) cm, which was greater than that in control group (0.104 7±0.018 1)cm, and the difference was statistically significant ( t=-2.688, P<0.05). DTf in the intervention group was lower than that in control group at 7th day, but the difference was not statistically significant(left DTf: adjusted mean difference was -0.117, P=0.088; right DTf: adjusted mean difference was -0.065, P=0.277). The incidence of VIDD in the intervention group was lower than that in control group(33.3% vs.41.2%), but the difference was not statistically significant ( χ2=0.005, P=0.946). Conclusion:External diaphragmatic electrical stimulation may be helpful for alleviating diaphragmatic atrophy in mechanically ventilated children.However, whether the improvement of diaphragm atrophy is beneficial to clinical outcome still needs further study.
ABSTRACT
OBJECTIVE@#To observe the effect of ultrasound-guided acupoint electrical stimulation on the patients with diaphragmatic dysfunction associated with mechanical ventilation in ICU.@*METHODS@#Fifty-two patients were randomly divided into an observation group (26 cases, 3 cases dropping) and a control group (26 cases). Conventional treatment was given to all patients. On the basis of conventional treatment, acupoint electrical stimulation therapy was applied at Zhangmen (LR 3), Dabao (SP 21), Pishu (BL 20), Shenshu (BL 23), etc. In the observation group, the treatment was given for 30 min each time, 3 times a day for 7 days. Diaphragm thickening fraction (TFdi) was used as an index to guide the individualized setting of stimulation intensity and judge the effect, and the difference of mechanical ventilation time, ICU time, total hospitalization time, hospital mortality and reintubation rate between the two groups were observed.@*RESULTS@#The mechanical ventilation time in the observation group was shorter than that in the control group (0.05). During hospitalization, 2 patients died in the observation group and 3 patients died in the control group, there was no significant difference in hospital mortality (>0.05). One patient in the observation group was reintubated and 8 patients in the control group (<0.05). The use of acupoint electrical stimulation was a factor in shortening the mechanical ventilation time and reducing the reintubation events (<0.05).@*CONCLUSION@#Ultrasound-guided acupoint electrical stimulation can relieve ventilator-induced diaphragmatic dysfunction, reduce ventilator support time and reintubation events.
Subject(s)
Humans , Acupuncture Points , Diaphragm , Electric Stimulation , Electric Stimulation Therapy , Respiration, ArtificialABSTRACT
Point-of-care ultrasonography has become a widely used diagnostic tool in the intensive care units and during perioperative settings. Nowadays, ultrasound has been also employed to evaluate diaphragmatic function. Some advantages of this method include safety, absence of ionizing radiation, and availability of real-time bedside examinations. The aim of this review is to promote the use of diaphragmatic ultrasound assessment among anesthesiologists and intensive care physicians. This article describes the standard diaphragmatic ultrasound technique and the knowledge required in order to monitor and diagnose diaphragmatic dysfunction; emphasizing its use in the operating room and in the different fields of clinical application.
El ultrasonido point-of-care se ha convertido en una herramienta diagnóstica ampliamente utilizada en unidades de cuidados intensivos y durante el período peri-operatorio. En la actualidad, el ultrasonido esta siendo empleado además para evaluar la función diafragmática. Las ventajas de este método incluyen seguridad, ausencia de radiación ionizante y posibilidad de realizar examinación en tiempo real a la cabecera del paciente. El objetivo de esta revisión es promover el uso de la evaluación sonográfica del diafragma para médicos anestesiólogos e intensivistas. Este artículo describe la técnica estándar de la evaluación sonográfica del diafragma y el conocimiento requerido para el diagnóstico y monitorización de la disfunción diafragmática, enfatizando el uso en quirófano y en los diferentes campos de aplicación clínica.
ABSTRACT
A pesquisa descrita neste artigo teve por objetivo avaliar quali-quantitativamente os efeitos da estimulação diafragmática transcutânea sincronizada em portadores de DPOC. Para isso, desenvolveu-se um sistema de estimulação elétrica controlado pelo sinal respiratório, a partir das variações de temperatura durante os eventos de inspiração e expiração, medidas por meio de dois termistores do tipo NTC inseridos dos lados interno e externo de uma máscara de respirador. Seis voluntários portadores de DPOC, de ambos os sexos, com idade entre 56 e 71anos, foram submetidos a 10 sessões estimulatórias de 20 minutos. O padrão do sinal estimulatório continha pulsos com duração de 90μs e repouso de 400μs, gerados em intervalos regulares e modulados em bursts com período ativo de 1470μs e inativo de 600μs, apresentando perfil trapezoidal com tempos de subida, descida e platô de 500ms cada. Todos os pacientes foram submetidos a uma avaliação inicial contendo: teste de força muscular respiratória avaliada por meio de PImáx e PEmáx, teste de função pulmonar e aplicação do questionário de qualidade de vida SGRQ. Após 10 sessões, houve um aumento na força muscular inspiratória em todos os pacientes, onde a PImáx sofreu um incremento médio de 66,67± 12,11cmH2O para 91,67 ± 25,03 cmH2O, a PEmáx de 92,50 ± 10,84 cmH2O para 116,67 ± 8,16 cmH2O. Também observou-se melhora da qualidade de vida no domínio sintoma, de 49,10± 19,40 para 28,60± 25,20; no domínio atividade, de 83,40± 12,50 para 67,57± 18,80; no domínio impacto, de 54,10± 11,34 para 38,00± 27,07; e escore total, de 65,50± 7,60 para 44,47± 22,31. A partir desses resultados, concluiu-se que a estimulação elétrica diafragmática sincronizada pode promover resultados positivos em portadores de DPOC.
The research described in this paper has the goal of evaluating the effects of transcutaneous diaphragmatic synchronized pacing in patients with COPD. In order to achieve the experimental protocol, it has been developed a system for electrical stimulation triggered by the respiratory signal obtained from the temperature variations during inspiration and expiration events, using two NTC thermistors coupled inside and outside of a respirator mask. It was studied six volunteers with COPD, of both sexes, aged between 56 to 71 years, who were submitted to 10sessions of 20minutes. The stimulatory parameters were set to: active phase of the pulse of 90μs, and inactive phase of 400μs, generated at regular intervals and modulated in bursts with active and inactive periods of 1470μs and 600μs, respectively; presenting trapezoidal envelope with rise time, fall time and plateau of 500ms. All patients underwent an initial assessment including: test of respiratory muscle strength seen through the MIP and MEP tests, lung function test and application of SGRQ quality of life questionnaire. After 10 sessions, there is an increasing inspiratory muscle strength in all patients, where MIP has an average increase of 66.67± 12.11cmH2O to 91.67 ± 25.03 cmH2O, MEP from 92.50 ± 10.84 cmH2O to 116.67 ± 8.16 cmH2O, and also observed a better quality of life in the symptom domain of 49.10± 19.40 to 28.60± 25.20, in the activity domain of 83.40± 12.50 to 67.57± 18.80, and in the impact domain of 54.10± 11.34 to 38.00± 27.07 and total score of 65.50± 7.60 to 44.47± 22.31. Therefore, we concluded that the transcutaneous diaphragmatic synchronized pacing can promote positive outcomes in patients with COPD.