Effects of transcutaneous electrical diaphragmatic stimulation in critically ill elderly patients: a randomized controlled trial

Background: Elderly patients under invasive mechanical ventilation (IMV) are more susceptible to muscle weakness. In the out-of-hospital environment, there are benefits to transcutaneous electrical diaphragmatic stimulation (TEDS), which is an easy-to-apply and low-cost technique.Objective: To evaluate the effect of TEDS on respiratory muscle strength, diaphragm thickness (DT), and IMV time in critically ill elderly patients.Methods: This was a randomized controlled trial in which patients were divided into an experimental group (EG) and a control group (CG). TEDS started 24 h after orotracheal intubation and lasted until the end of weaning. Both groups underwent the following assessments during the spontaneous breathing test after weaning from mechanical ventilation (MV): measurement of respiratory muscle strength by pressure gauge, analysis of DT by lung ultrasound, and extubation failure prevention checklist.Results: There were 23 participants in the EG and 21 in the CG. The median age was 66 (60-79) years. The mean values of the diaphragmatic thickening index in the EG and CG participants were 99.13 +/- 26.75 and 66.88 +/- 31.77, respectively (p = .001, Cohen's d = 1.094). The mean values of maximum inspiratory pressure in the EG and CG were 22.04 +/- 3.41 and 19.34 +/- 4.23 cmH(2)O, respectively (p = .005, Cohen's d = 0.698). The Tobin index and the integrative weaning index were similar between groups (p = .584 and p = .102, respectively). The duration of MV in the EG and CG was 6.28 +/- 2.68 and 9.21 +/- 2.76 days, respectively (p = .001, Cohen's d = -1.075).Conclusion: Critically ill elderly patients receiving TEDS had shorter MV time, greater inspiratory muscle strength, and greater diaphragmatic contraction capacity according to their thickness fraction.