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Randomized Controlled Trial
. 2023 Aug 30;27(1):338.
doi: 10.1186/s13054-023-04597-1.

Transcutaneous electrical diaphragmatic stimulation in mechanically ventilated patients: a randomised study

Clément Medrinal  1   2 , Margaux Machefert  3   4 , Bouchra Lamia  5   6   7   8 , Tristan Bonnevie  5   6   9 , Francis-Edouard Gravier  5   6   9 , Roger Hilfiker  10 , Guillaume Prieur  11   7 , Yann Combret  3   11   7
Affiliations
Randomized Controlled Trial

Transcutaneous electrical diaphragmatic stimulation in mechanically ventilated patients: a randomised study

Clément Medrinal et al. Crit Care. .

Abstract

Background: 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.

Methods: 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.

Results: 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 cmH20; 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.

Conclusion: TEDS did not prevent diaphragm dysfunction or improve inspiratory muscle strength in mechanically ventilated patients.

Trial registration: Prospectively registered on the 20th November 2019 on ClinicalTrials.gov Identifier NCT04171024.

Keywords: Diaphragm dysfunction; Electrical stimulation; Intensive care unit; Mechanical ventilation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study
Fig. 2
Fig. 2
a Comparison between intention to treat and per protocol analysis for dichotomic outcomes. Data are as odds ratios and 95% confidence intervals. *Data are hazard ratios and 95% confidence intervals. CI, confidence interval; DTF, diaphragm thickening fraction; SBT, spontaneous breathing trial; MV, mechanical ventilation; D28, 28 days. b Comparison between intention to treat and per protocol analysis for continuous outcomes. MIP, maximal inspiratory pressure; PEF, peak cough flow; ICU LOS, intensive care unit length of stay
Fig. 3
Fig. 3
Individual percentage of change in diaphragm thickness during the study between TEDS and Sham Groups. The change was calculated as the difference between the first and last days
See this image and copyright information in PMC

References

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