Ruiz PR, Sosa BJ, Chávez MA, Sandia ZMA, Hernández BA

Language: Spanish
References: 10
Page: 205-212
PDF size: 283.52 Kb.

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 «A» received electro-muscle stimulation of the diaphragm two 15-minute sessions per day; group «B», three 15- minute sessions per day, and group «C», 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.

REFERENCES

1. Mayo P, Volpicelli G, Lerolle N, Schreiber A, Doelken P, Vieillard-Baron A. Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung. Intensive Care Med. 2016;42(7):1107-1117.

2. Hodgson LE, Murphy PB. Update on clinical trials in home mechanical ventilation. J Thorac Dis. 2016;8(2):255-267.

3. Zanforlin A, Bezzi M, Carlucci A, DI Marco F. Clinical applications of diaphragm ultrasound: moving forward. Minerva Med. 2014;105(5 Suppl. 1):1-5.

4. Schepens T, Verbrugghe W, Dams K, Corthouts B, Parizel PM, Jorens PG. The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study. Critical Care. 2015;19:422.

5. Layachi L, Georges M, Gonzalez-Bermejo J, Brun AL, Similowski T, Morélot-Panzini C. Diaphragm pacing failure secondary to deteriorated chest wall mechanics: When a good diaphragm does not suffice to take a good breath in. Respir Med Case Rep. 2015;15:20-23.

6. Di Mussi R, Spadaro S, Mirabella L, Volta CA, Serio G, Staffieri F, et al. Impact of prolonged assisted ventilation on diaphragmatic efficiency: NAVA versus PSV. Crit Care. 2016;20:1.

7. Heunks LM, Doorduin J, van der Hoeven JG. Monitoring and preventing diaphragm injury. Curr Opin Crit Care. 2015;21:34-41.

8. Dos Santos LJ, de Aguiar LF, Bianchi T, Sachetti A, Dall’AA, da Silva NW, et al. Early rehabilitation using a passive cycle ergometer on muscle morphology in mechanically ventilated critically ill patients in the Intensive Care Unit (MoVe-ICU study): study protocol for a randomized controlled trial. Trials. 2015;16:383.

9. Umbrello M, Formenti P, Longhi D, Galimberti A, Piva I, Pezzi A, et al. Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study. Crit Care. 2015;19:161.

10. Hudson MB, Smuder AJ, Nelson WB, Wiggs MP, Shimkus KL, Fluckey JD. Partial support ventilation and mitochondrial-targeted antioxidants protect against ventilator-induced decreases in diaphragm muscle protein synthesis. Plos One. 2015;10(9): e0137693.