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Electrical stimulation of the expiratory muscles to maintain muscle activity during the acute stages of mechanical ventilation: a pilot RCT

Introduction: Expiratory abdominal wall muscle weakness leads to difficult ventilator weaning. Maintaining their activity with functional electrical stimulation (FES) may improve outcome. We assessed feasibility and efficacy of breath-synchronized abdominal FES in a mixed ICU population (“Holland study”) and pooled data with our previous work [1] to analyze effects in a larger group. Methods:Holland: 20 patients with contractile response to FES received active or sham abdominal FES for 30-min, 2-daily, 5 d/wk until weaned. Endpoints: feasibility, safety, respiratory muscle thickness, ventilation duration and ICU length-of-stay (LoS). Pooled: Clinical endpoints were combined (n=40) and plasma cytokines (day 0, 3) were analyzed. Results:H: 272 sessions were performed (sham/active: 103/169) with a session compliance of 91.1%. No adverse events were related to FES. Respiratory muscle thickness did not change. P: Early FES did not induce inflammation. Median ventilator duration and ICU LoS (F1) were 10 vs. 52 (P=0.07), and 12 vs. 54 (P=0.03) days for active vs. sham group. 9/20 patients died in the sham group, vs. 3/20 in the active group (P=0.08). Discussion: Abdominal FES is feasible in selected ICU patients and may be a novel intervention within a respiratory muscle-protective ventilation strategy. The effects on weaning outcome remain to be studied. 1.McCaughey, CC 2019