Transcutaneous electrical diaphragmatic stimulation reduces the duration of invasive mechanical ventilation in patients with cervical spinal cord injury: retrospective case series

Abstract

Study design Retrospective case series. Objectives To compare individuals with cervical spinal cord injury (SCI) submitted to transcutaneous electrical diaphragmatic stimulation (TEDS) or a standard weaning protocol (SWP) according to the following variables: invasive mechanical ventilation (IMV) time, ventilator weaning time, intensive care unit (ICU) length of stay, and overall hospital length of stay. Settings Tertiary university hospital. Clinical Hospital of Campinas State University—UNICAMP—Campinas (SP), Brazil. Methods Retrospective case study investigating ICU patients submitted to tracheostomy due to cervical SCI at a tertiary university hospital (Clinical Hospital of Campinas State University, Brazil). Data were extracted from medical records of patients seen between January 2007 and December 2016. According to medical records, four patients were submitted to TEDS and six to a SWP. Provision of training to patients in the TEDS group was based on consensus medical decision, preference of the physical therapy team and availability of electrostimulation equipment in the ICU. Results Total IMV time in the TEDS and the SWP group was 33 ± 15 and 60 ± 22 days, respectively. Length of stay in ICU in the TEDS and the SWP group was 31 ± 18 and 63 ± 45 days, respectively. Conclusion TEDS appears to influence the duration of IMV as well as the length of stay in ICU. This physiotherapeutic intervention may be a potentially promising tool for treatment of patients with SCI. However, randomized clinical trials are warranted to support this assumption.

Immediate Hemodynamic Responses to Transcutaneous Electrical Diaphragmatic Stimulation in Critically Ill Elderly Patients

“…Interestingly, a recent study conducted by Duarte et al [ 28 ] suggested that TEDS influences the duration of IMV as well as the length of stay in the ICU in patients with spinal cord injury (SCI). Unlike the retrospective case series evaluated by these authors ( n = 10), our study is an experimental clinical trial evaluating the influence of TEDS on immediate hemodynamic responses to determine the safety of the procedure in critically ill elderly individuals (not only patients with SCI).…”

“…Unlike the retrospective case series evaluated by these authors ( n = 10), our study is an experimental clinical trial evaluating the influence of TEDS on immediate hemodynamic responses to determine the safety of the procedure in critically ill elderly individuals (not only patients with SCI). Additionally, Duarte et al [ 28 ] proposed a comparison between TEDS and the standard weaning protocol in neurological patients who were already able to voluntarily contract their respiratory muscles. In contrast, we analyzed the application of TEDS in patients initially without ventilatory drive, thus allowing identification of new evidence to assess the impact of TEDS earlier, which is important because critical patients newly admitted to the ICU receive sedative and analgesic agents, justifying the decrease in the ventilatory drive and contributing to ICU-AW [ 29 ].…”

Rehabilitation interventions for weaning from mechanical ventilation in patients with spinal cord injury: A systematic review

“…As a result, 332 records were excluded, and 31 studies were subsequently screened in full text. Lastly, 14 studies [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] were included in the present systematic review. Figure 1 shows further details about the article selection process through the PRISMA flow diagram.…”

Regulation of Human Respiration by Electrical Stimulation

“…Transcutaneous electrical diaphragmatic stimulation (TEDS) is aimed at activating and training of intact muscle fibers that elicit diaphragmatic contractions. TEDS prevents muscular hypotrophy, including in patients with neuromuscular diseases and those dependent on artificial lung ventilation [ 7 , 8 ].…”

“…In a retrospective study, there were analyzed the 2007–2016 medical records of intensive care patients with cervical SCI [ 7 ]. Out of 13 tracheostomized patients, 4 received a 7-week course of TEDS (30 Hz, 60 mA, pulse duration 1 ms), 6 were run along a standard ALV protocol, while the remaining patients were excluded from the analysis due to data incompleteness or death.…”