Abdominal Functional Electrical Stimulation to Assist Ventilator Weaning in Acute Tetraplegia: A Cohort Study

Abstract

BackgroundSevere impairment of the major respiratory muscles resulting from tetraplegia reduces respiratory function, causing many people with tetraplegia to require mechanical ventilation during the acute stage of injury. Abdominal Functional Electrical Stimulation (AFES) can improve respiratory function in non-ventilated patients with sub-acute and chronic tetraplegia. The aim of this study was to investigate the clinical feasibility of using an AFES training program to improve respiratory function and assist ventilator weaning in acute tetraplegia.MethodsAFES was applied for between 20 and 40 minutes per day, five times per week on four alternate weeks, with 10 acute ventilator dependent tetraplegic participants. Each participant was matched retrospectively with a ventilator dependent tetraplegic control, based on injury level, age and sex. Tidal Volume (VT) and Vital Capacity (VC) were measured weekly, with weaning progress compared to the controls.ResultsCompliance to training sessions was 96.7%. Stimulated VT was significantly greater than unstimulated VT. VT and VC increased throughout the study, with mean VC increasing significantly (VT: 6.2 mL/kg to 7.8 mL/kg VC: 12.6 mL/kg to 18.7 mL/kg). Intervention participants weaned from mechanical ventilation on average 11 (sd: ± 23) days faster than their matched controls.ConclusionThe results of this study indicate that AFES is a clinically feasible technique for acute ventilator dependent tetraplegic patients and that this intervention may improve respiratory function and enable faster weaning from mechanical ventilation.Trial RegistrationClinicalTrials.gov NCT02200393

Abdominal functional electrical stimulation to assist ventilator weaning in critical illness: a double-blinded, randomised, sham-controlled pilot study

“…Functional electrical stimulation (FES) is the application of a train of electrical pulses to a motor nerve, causing the associated muscle to contract. Transcutaneous FES of the abdominal muscles, termed abdominal FES, can improve respiratory function [10–13] and assist ventilator weaning in spinal cord injury [12, 14]. Unlike inspiratory muscle training, which has been shown to improve weaning outcomes for difficult to wean patients [15, 16], abdominal FES does not require patient participation or cooperation [16].…”

Abdominal functional electrical stimulation to improve respiratory function after spinal cord injury: a systematic review and meta-analysis

“…While outside the scope of this review, two articles have also reported that Abdominal FES can be used to assist ventilator weaning for patients with SCI. 46,47 Further research may indicate that this intervention is suitable for other ventilator dependent patient groups. Finally, Butler et al 2 and Lin et al 32 showed that combining Abdominal FES with an abdominal binder led to an acute increase in CPF, with Lin et al finding that for 12 tetraplegic patients this increase was significantly greater than that achieved using the binder alone.…”

Influência do fortalecimento do músculo reto abdominal sobre função pulmonar em tetraplégico: relato de caso

“…conforme segue a tabela 1. A técnica é clinicamente viável para pacientes tetraplégicos, especialmente aos dependentes de ventilador agudo, pois desencadeia uma melhora significativa da função respiratória, permitindo que o paciente deixa de usar mais rápido a ventilação mecânica (MCCAUGHEY et al, 2015).…”