Resumen

RUIZ PEREZ, Raúl et al. Electroestimulation of the diaphragm muscle for the early withdrawal of mechanical ventilation and monitoring changes in thickness with ultrasound. Med. crít. (Col. Mex. Med. Crít.) [online]. 2017, vol.31, n.4, pp.205-212. ISSN 2448-8909.

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.

Palabras llave : Diaphragm muscle; electro-stimulation; atrophy; mechanical ventilation.

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