Application Of Respiratory Neuromuscular Electrical Stimulation In Rehabilitation Of Diaphragm Function In Critically Ill Patients

Objective:Use ultrasound to evaluate diaphragm function in mechanically ventilated patients,and explore the application effect of respiratory neuromuscular electrical stimulation in mechanically ventilated patients.Methods:This study is a randomized controlled clinical study.From July 2019 to February 2021,110 mechanically ventilated patients who were admitted to the Department of Critical Care Medicine in a comprehensive grade-A tertiary teaching hospital in Anhui Province with a diaphragm thickening fraction（DTF）<20%measured by ultrasound were selected in the study,randomly divided into intervention group and control group with 55 cases each.The observation period of this study was from the beginning of the study until the patient was discharged from the ICU,compare the DTF and diaphragm excursion（DE）of the two groups of patients during the first 7 days（T1-T7）of the intervention,DTF and DE at the first extubation（T8）,mechanical ventilation time,reintubation rate,tracheotomy rate,ICU mortality rate,ICU hospital stay and total hospital stay during the course of the disease.To explore the effect of external respiratory neuromuscular electrical stimulation in diaphragm rehabilitation of mechanically ventilated patients,as well as other clinical indicators.Results:110 patients were included,of which 16 were excluded because the mechanical ventilation time was less than 7 days,5 were transferred to hospitals or departments,and 2 voluntarily withdrew from the study.Finally,44 subjects in the intervention group and 43 subjects in the control group were subjected to statistical analysis.The baseline data of the two groups of patients such as age,gender,APACHEⅡscore,BMI,HR,MAP,p H,Pa CO₂,Pa O₂/Fi O₂,Lac,DTF,DE,MIP,and the number of days of mechanical ventilation at the time of inclusion in the study were in good agreement（P>0.05）.For the main outcome indicator DTF,the results of the two-way repeated measures of ANOVA showed that there were statistical differences between the group effect,the time effect and the interaction between the two（all P<0.001）.Analyzing the effect between groups,the measured values of DTF at the intervention group at T3（18.13±1.48）%,T4（22.19±1.48）%,T5（23.40±1.99）%,T6（25.04±1.79）%,T7（28.85±5.23）%and T8（36.24±9.69）%were higher than those of the control group at T3（17.09±1.39）%,T4（18.45±2.34）%,T5（20.82±2.17）%,T6（22.27±1.05）%,T7（25.18±5.36）%and T8（31.52±6.4）%（all P<0.05）;analyze time effects,the DTF measured by T3,T4,T5,T6,T7,and T8 in the intervention group were compared with T0（17.22±1.29）%（at the time of enrollment）,and the differences were statistically significant（all P<0.05）;the DTF measured by T4,T5,T6,T7,and T8 in the control group were compared with T0（17.46±1.16）%,and the differences were statistically significant（all P<0.05）.For the outcome indicator DE,the results of the two-way repeated measures of ANOVA showed that there were statistical differences between the group effect,the time effect and the interaction between the two（all P<0.001）.Analyzing the effect between groups,the measured values of DE at T5（8.34±1.37）mm,T6（12.53±1.22）mm,T7（14.08±1.50）mm and T8（8.83±6.40）mm in the intervention group were higher than those of the control group at T5（7.36±1.52）mm,T6（11.00±2.22）mm,T7（12.77±2.91）mm and T8（14.15±3.09）mm（all P<0.05）.Analyze time effects,the DE measured by T5,T6,T7,and T8 in the intervention group were compared with T0（7.37±1.38）mm,and the differences were statistically significant（all P<0.05）;the DE measured by T7,T8 in the control group were compared with T0（7.38±0.77）mm,and the differences were statistically significant（all P<0.05）.For the main outcome index maximum inspiratory pressure（maximum inspiratory pressure,MIP）,the MIP（34.25±8.00）cm H₂O of patients in the intervention group was significantly higher than the MIP（20.89±3.97）cm H₂O at the time of enrollment in the study（P<0.001）;the MIP（24.34±4.10）cm H₂O of patients in the control group at the first weaning and extubation was higher than the MIP（22.02±5.48）cm H₂O at the time of enrollment in the study（P=0.029）;and the MIP of patients in the intervention group was higher than that in the control group when they were weaned and extubated for the first time（P<0.001）.Among the secondary outcome indicators,the differences in mechanical ventilation time,total mechanical ventilation time,reintubation rate,tracheotomy rate,and ICU hospital stay were statistically different between the two groups（all P<0.05）.Conclusion:This study did not find adverse effects of electrical stimulation of respiratory nerves and muscles.Respiratory neuromuscular electrical stimulation can help improve the patient’s diaphragm function,reduce mechanical ventilation time and ICU hospital stay,reduce reintubation rate and tracheotomy rate.