Dados do Trabalho

Título

Enhancing diaphragmatic function in critically ill patients: the impact of abdominal support during spontaneous breathing

Objetivo

To assess the impact of abdominal wall support on the diaphragm's contraction capacity in critically ill patients.

Métodos

This pilot randomized cross-over trial was conducted in two ICUs at the Hospital das Clínicas, University of São Paulo. Adults breathing spontaneously without mechanical ventilation, and with a Glasgow Coma Scale score ≥ 14 were included. Patients with neurological diseases, thoracic traumas and ascites were excluded. Participants underwent two interventions in a randomized order: diaphragmatic breathing with an abdominal belt loosely placed, without any tension (Intervention 1); and diaphragmatic breathing with an abdominal belt applying a standardized tension of 10 mmHg (Intervention 2). Diaphragm excursion (DE), thickening fraction (TFdi) and maximal inspiratory pressure (MIP) were measured in baseline, intervention 1 and intervention 2. Statistical significance was set at p<0.05.

Resultados

Thirty patients with a mean age of 55.5 ± 17.9 years were included. The most common cause of admission was surgical (n=21, 70%), and the disease severity characterized by the SAPS III score, was 45.7 ± 15.0. MIP was significantly higher (p<0.001) during the intervention 2 (59.0±24.9 cmH2O vs. 48.93±23.5 cmH2O, respectively). Comparison of DE (22.0±5.4 vs. 47.2±15.6 vs. 58.5±16.4, p < 0.001) and TFdi (38.0±9.7 vs. 40.8±19.7 vs. 76.2±27.5, p < 0.001) across baseline, Intervention 1, and Intervention 2, respectively, revealed significant improvement.

Conclusão

Abdominal support enhances diaphragmatic contraction capacity, leading to improved MIP, DE, and TFdi in critically ill patients.