Effect of transcutaneous neuromodulation on predictive parameters of extubation failure in severe acute pancreatitis: A case report
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Héctor Hernández-Garcés 1 , Francisco Selva-Sarzo 2 3 * , Alberto Belenguer-Muncharaz 1 , Samuel Fernández-Carnero 3 4 , Eleuterio A Sánchez-Romero 3 5 6 * , Rafael Zaragozá-Crespo 1
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1 Department of Intensive Care Medicine, Doctor Peset University Hospital, Valencia, SPAIN2 Department of Physiotherapy, University of Valencia, Valencia, SPAIN3 Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, SPAIN4 Department of Physiotherapy, Faculty of Nursing and Physiotherapy, University of Alcalá, Alcalá de Henares, SPAIN5 Department of Rehabilitation, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, SPAIN6 Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute-Segovia de Arana, Madrid, SPAIN* Corresponding Author

Abstract

Background: Complications of pancreatitis can lead to admission to the intensive care unit (ICU) with invasive mechanical ventilation. Reducing the duration of mechanical ventilation is challenging for critical care practitioners. Respiratory muscle weakness hinders the weaning process, thereby increasing the duration of mechanical ventilation and hindering pulmonary rehabilitation.
Methods: We evaluated the effect of transcutaneous neuromodulation on predictors of extubation failure. The patient was a 51-year-old male with a history of type 2 diabetes, obesity (body mass index=35), and regular alcohol consumption of 40 g/day. The patient was admitted to ICU with a diagnosis of severe acute pancreatitis and multi-organ failure. Maximum inspiratory pressure (MIP), airway occlusion pressure at 100 ms (P0.1), rapid shallow breathing index (RSBI), and diaphragmatic thickening fraction (DTf) were measured.
Results: The results demonstrated an improvement in all the parameters. Show an increase in MIP from -18 cmH2O to -37 cmH2O and a reduction in P0.1 from -5.7 cmH2O to -3.1 cmH2O. RSBI decreased from 107 to 72, and DTf increased from 20% to 35%. The patient was extubated successfully and discharged to the ward after a 28-day ICU stay.
Conclusions: The application of transcutaneous neuromodulation led to an improvement in the predictive parameters of extubation failure in patients with severe acute pancreatitis, which was ultimately confirmed by ventilatory support not being required after extubation. Transcutaneous neuromodulation application helps improve respiratory parameters and systemic improvement of the patient until he is released from ICU. Transcutaneous neuromodulation should be used in combination with other physiotherapy techniques and should be included in a comprehensive rehabilitation protocol rather than as an isolated therapy.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Case Report

ELECTRON J GEN MED, Volume 21, Issue 5, October 2024, Article No: em599

https://doi.org/10.29333/ejgm/14781

Publication date: 01 Sep 2024

Online publication date: 09 Jul 2024

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