Efeito da estimulação diafragmática elétrica transcutânea na força muscular respiratória, na espessura do diafragma e no tempo de ventilação mecânica de pacientes críticos idosos

Abstract

Critical patients admitted to the ICU may develop diaphragmatic dysfunction (DD). Among the muscles affected by staying on IMV in the general population and especially in the elderly, the diaphragm can be highlighted, which evolves with a reduction in its capacity to generate tension due to the atrophy of its muscle fibers. The first article aimed to evaluate the influence of TEDS on the hemodynamic and vital parameters of critically ill elderly people under IMV. The objective of the second article was to evaluate the influence of TEDS on respiratory muscle strength, diaphragm thickness and duration of mechanical ventilation in elderly critically ill patients under intensive care. Research participants were divided into GC and GE. In the first article, all participants were submitted to hemodynamic evaluation before and after TEDS application. They underwent the same evaluation steps, and the variables systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate were measured immediately before and after the intervention. In the second article, the evaluation was performed during SBT after weaning from mechanical ventilation, with only the EG undergoing TEDS. The evaluations consisted of MIP analysis, DTF analysis through USGD and an institutional extubation failure prevention checklist. The intervention with TEDS started 24 hours after orotracheal intubation, and was performed twice a day, lasting 30 minutes, until the end of the ventilatory weaning process. In the first article, the following results were found: the sample consisted of 33 men and 14 women, with a mean age of 69.9 ± 7.64 years. Mean pre-EDET and post-EDET systolic blood pressure were 126.6 ± 23.7 and 122.9 ± 25.9, respectively (p = 0.467). Mean pre-EDET and post-EDET diastolic blood pressure was 71.1 ± 12.2 and 67.7 ± 14.2, respectively (p = 0.223). There were no significant differences in mean arterial pressure or heart rate between pre-EDET and post-EDET time points (p = 0.335 and p = 0.846, respectively). In the second article, the following results were found: the sample consisted of 44 patients, 28 female, with a median age of 66 (60 – 79). The mean value referring to the DTF in the CG patients was 66.88 ± 31.77, while in those belonging to the EG, the result was 99.13 ± 26.75, (p = 0.001) . It was possible to observe in the MIP variable the median value of 65.75 (42.06–95.92) (p=0.005). The predictive indices of IRRS and IWI weaning did not present a significant difference in the analysis between the groups (p = 0.584 and p = 0.102) and, in relation to the duration of mechanical ventilation, the mean value in the CG was 9.21 ± 2.76 , while in the EG, the result was 6.28 ± 2.68 (p=0.001). TEDS proved to be hemodynamically safe and also provided a reduction in mechanical ventilation time, optimized MIP and increased EDF in elderly critically ill patients