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.

Teaching point-of-care transfontanellar ultrasound for pediatricians and medical students

Abstract Objectives: The authors aim to evaluate the ''point-of-care'' transfontanellar ultrasound (TU) as an extension to pediatric physical examination and suggest a TU teaching protocol. Methods: The students were randomly divided into two groups, group A (12 participants) and group B (15 participants). The first group only received theoretical training, while the second group received theoretical and practical training. A third group, group C, included 15 pediatricians and interns who also received theoretical and practical training. All the participants underwent multiple-choice testing before and after a four-hour short course on TU. Six months later, another evaluation was performed to analyze the retained knowledge. Furthermore, a questionnaire based on the Likert scale was administered to evaluate satisfaction. Results: The cognitive evaluation (maximum score = 10 points) before and after training increased in group A from 4,0 ± 1,04 to 7,5 ± 1,2 (p < 0.001) and, 6 months later, to 6,5 ± 1,16 (p < 0.003); in group B from 3,8 ± 1,24 to 8,8 ± 1,01 (p < 0.001) and, 6 months later, to 8,46 ± 0,91 (p < 0.001); and in group C from 6,0 ± 0,75 to 9,0 ± 0,75 (p < 0.001) and, 6 months later, to 8,8 ± 0,77 (p < 0.001). The average satisfaction estimated by the Likert scale was over 80% for all questions. Conclusion: Cognitive assessment before and after classes and training reveals progress in learning, with knowledge retention in 6 months. Theoretical-practical courses are well accepted.

Association between ventilatory efficiency, oxygen uptake, and Glittre-ADL test results in patients with chronic heart failure: a preliminary study.

OBJECTIVE: The Glittre-ADL test (GA-T) is a functional capacity test that stands out for encompassing multiple tasks similar to activities of daily living. As ventilatory efficiency is one of the variables valued in the prognosis of chronic heart failure (CHF), this study aimed to evaluate associations between functional capacity and ventilatory variables in patients with CHF during the GA-T. RESULTS: Eight patients with CHF and New York Heart Association (NYHA) functional classification II-III underwent the GA-T coupled with metabolic gas analysis to obtain data by means of telemetry. The median total GA-T time was 00:04:39 (00:03:29-00:05:53). Borg dyspnoea scale scores before and after the GA-T were 2 (0-9) and 3 (1-10), respectively (P = 0.011). The relationship between the regression slope relating minute ventilation to carbon dioxide output (VE/VCO2 slope) was correlated with the total GA-T time (rs = 0.714, P = 0.047) and Borg dyspnoea score (rs = 0.761, P = 0.028). The other ventilatory variables showed no significant correlations. Our results suggest that the total GA-T time can be applied to estimate the ventilatory efficiency of patients with CHF. Future studies may use the GA-T in conjunction with other functional capacity tests to guide the treatment plan and evaluate the prognosis.

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.