[Effect of external diaphragmatic pacing on diaphragmatic function and weaning success rate in patients with acute exacerbations of chronic obstructive pulmonary disease undergoing invasive mechanical ventilation].
To investigate whether the addition of external diaphragmatic pacing (EDP) to standard therapy can effectively improve diaphragmatic dysfunction in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) requiring invasive mechanical ventilation, and increase the likelihood of successful weaning.
A prospective randomized controlled trial (RCT) was conducted. A total of 174 patients with AECOPD undergoing invasive mechanical ventilation who were admitted to the Department of Critical Care Medicine of Hengshui People's Hospital from November 1, 2022 to January 31, 2025 were enrolled. Patients were divided into a control group and an EDP group using a block randomization method, with 87 patients in each group. The control group received conventional therapy; the EDP group received conventional treatment combined with EDP. Baseline characteristics, primary outcome, and secondary outcomes were collected and compared between the two groups. The primary outcome was weaning success rate. Secondary outcomes included respiratory function parameters (peak airway pressure, plateau pressure, airway resistance, and respiratory rate), heart rate, arterial blood gas results [partial pressure of arterial carbon dioxide (PaCO2), partial pressure of arterial oxygen (PaO2), and oxygenation index (PaO2/FiO2)], diaphragmatic function [diaphragmatic excursion (DE) and diaphragmatic thickening fraction (DTF)], and prognostic indicators [duration of mechanical ventilation, intensive care unit (ICU) length of stay, reintubation rate, ICU mortality, 28-day post-ICU discharge mortality, and overall mortality].
There were no statistically significant differences in baseline characteristics such as gender, age, body mass index (BMI), COPD duration, comorbidities, PaO2/FiO2, Acute Physiology and Chronic Health Evaluation II(APACHE II), and Sequential Organ Failure Assessment (SOFA) between the two groups. In terms of the primary outcome, the weaning success rate after treatment in the EDP group was higher than that in the control group [93% (81/87) vs. 61% (53/87), P<0.05]. Regarding secondary outcomes, there were no statistically significant differences in airway peak pressure, plateau pressure, airway resistance, respiratory rate, heart rate, PaCO2, PaO2, PaO2/FiO2, DE, and DTF between the two groups before treatment. However, after treatment, all these parameters showed improvement, with more pronounced changes in the EDP group compared to the control group [peak airway pressure (cmH2O, 1 cmH2O=0.098 kPa): 24.86±7.12 vs. 31.03±8.05, plateau pressure (cmH2O): 18.05±4.97 vs. 23.08±6.21, airway resistance (cmH2O×L-1×s-1): 28.96±4.85 vs. 34.12±5.61, respiratory rate (breaths/min): 20.13±2.46 vs. 25.52±2.78, heart rate (beats/min): 71.32±3.68 vs. 79.06±3.24, PaCO2 (mmHg, 1 mmHg=0.133 kPa): 45.36±7.54 vs. 49.81±8.05, PaO2 (mmHg): 86.07±7.82 vs. 82.18±8.14, PaO2/FiO2 (mmHg): 253.57±51.96 vs. 201.83±45.37, DE (mm): 3.49±0.56 vs. 2.82±0.47, DTF: (35.72±4.59)% vs. (29.61±4.81)%, all P<0.05]. In addition, the duration of mechanical ventilation (days: 5.84±1.72 vs. 10.53±2.18) and length of ICU stay (days: 9.74±2.15 vs. 14.38±3.06) in the EDP group were shorter than those in the control group, and the 28-day post-ICU discharge mortality [7% (6/87) vs. 20% (17/87)] and overall mortality [9% (8/87) vs. 29% (25/87)] in the EDP group were lower than those in the control group (all P<0.05). However, there were no statistically significant differences between the two groups in reintubation rate or ICU mortality.
EDP intervention can significantly improve diaphragmatic function, reduce airway pressure and respiratory rate, shorten the duration of mechanical ventilation and length of ICU stay, increase weaning success rate, and reduce mortality. Thus, it provides high-quality, evidence-based support with clinical translational value for this high-risk patient population.
A prospective randomized controlled trial (RCT) was conducted. A total of 174 patients with AECOPD undergoing invasive mechanical ventilation who were admitted to the Department of Critical Care Medicine of Hengshui People's Hospital from November 1, 2022 to January 31, 2025 were enrolled. Patients were divided into a control group and an EDP group using a block randomization method, with 87 patients in each group. The control group received conventional therapy; the EDP group received conventional treatment combined with EDP. Baseline characteristics, primary outcome, and secondary outcomes were collected and compared between the two groups. The primary outcome was weaning success rate. Secondary outcomes included respiratory function parameters (peak airway pressure, plateau pressure, airway resistance, and respiratory rate), heart rate, arterial blood gas results [partial pressure of arterial carbon dioxide (PaCO2), partial pressure of arterial oxygen (PaO2), and oxygenation index (PaO2/FiO2)], diaphragmatic function [diaphragmatic excursion (DE) and diaphragmatic thickening fraction (DTF)], and prognostic indicators [duration of mechanical ventilation, intensive care unit (ICU) length of stay, reintubation rate, ICU mortality, 28-day post-ICU discharge mortality, and overall mortality].
There were no statistically significant differences in baseline characteristics such as gender, age, body mass index (BMI), COPD duration, comorbidities, PaO2/FiO2, Acute Physiology and Chronic Health Evaluation II(APACHE II), and Sequential Organ Failure Assessment (SOFA) between the two groups. In terms of the primary outcome, the weaning success rate after treatment in the EDP group was higher than that in the control group [93% (81/87) vs. 61% (53/87), P<0.05]. Regarding secondary outcomes, there were no statistically significant differences in airway peak pressure, plateau pressure, airway resistance, respiratory rate, heart rate, PaCO2, PaO2, PaO2/FiO2, DE, and DTF between the two groups before treatment. However, after treatment, all these parameters showed improvement, with more pronounced changes in the EDP group compared to the control group [peak airway pressure (cmH2O, 1 cmH2O=0.098 kPa): 24.86±7.12 vs. 31.03±8.05, plateau pressure (cmH2O): 18.05±4.97 vs. 23.08±6.21, airway resistance (cmH2O×L-1×s-1): 28.96±4.85 vs. 34.12±5.61, respiratory rate (breaths/min): 20.13±2.46 vs. 25.52±2.78, heart rate (beats/min): 71.32±3.68 vs. 79.06±3.24, PaCO2 (mmHg, 1 mmHg=0.133 kPa): 45.36±7.54 vs. 49.81±8.05, PaO2 (mmHg): 86.07±7.82 vs. 82.18±8.14, PaO2/FiO2 (mmHg): 253.57±51.96 vs. 201.83±45.37, DE (mm): 3.49±0.56 vs. 2.82±0.47, DTF: (35.72±4.59)% vs. (29.61±4.81)%, all P<0.05]. In addition, the duration of mechanical ventilation (days: 5.84±1.72 vs. 10.53±2.18) and length of ICU stay (days: 9.74±2.15 vs. 14.38±3.06) in the EDP group were shorter than those in the control group, and the 28-day post-ICU discharge mortality [7% (6/87) vs. 20% (17/87)] and overall mortality [9% (8/87) vs. 29% (25/87)] in the EDP group were lower than those in the control group (all P<0.05). However, there were no statistically significant differences between the two groups in reintubation rate or ICU mortality.
EDP intervention can significantly improve diaphragmatic function, reduce airway pressure and respiratory rate, shorten the duration of mechanical ventilation and length of ICU stay, increase weaning success rate, and reduce mortality. Thus, it provides high-quality, evidence-based support with clinical translational value for this high-risk patient population.