Breathing-synchronised electrical stimulation of the abdominal muscles in patients with acute tetraplegia: A prospective proof-of-concept study

Abstract

Objective: To examine whether, by enhancing breathing depth and expectoration, early use of breathing-synchronised electrical stimulation of the abdominal muscles (abdominal functional electrical stimulation, AFES) is able to reduce pulmonary complications during the acute phase of tetraplegia.

Design: Prospective proof-of-concept study.

Setting: Spinal cord unit at a level 1 trauma center.

Method: Following cardiovascular stabilisation, in addition to standard treatments, patients with acute traumatic tetraplegia (ASIA Impairment Scale A or B) underwent breathing-synchronised electrical stimulation of the abdominal muscles to aid expiration and expectoration. The treatment was delivered in 30-minute sessions, twice a day for 90 days. The target was for nine of 15 patients to remain free of pneumonia meeting Centers for Disease Control and Prevention (CDC) diagnostic criteria.

Results: Eleven patients were recruited to the study between October 2011 and November 2012. Two patients left the study before completion. None of the patients contracted pneumonia during the study period. No complications from electrical stimulation were observed. AFES led to a statistically significant increase in peak inspiratory and expiratory flows and a non-statistically significant increase in tidal volume and inspiratory and expiratory flow. When surveyed, 6 out of 9 patients (67%) reported that the stimulation procedure led to a significant improvement in breathing and coughing.

Conclusion: AFES appears to be able to improve breathing and expectoration and prevent pneumonia in the acute phase of tetraplegia (up to 90 days post-trauma). This result is being validated in a prospective multicentre comparative study.

Keywords:

• Acute traumatic tetraplegia
• Functional electrical stimulation
• Motor training of abdominal muscles
• Airway complications
• Pneumonia

Acknowledgments

We thank Maryna Verba for compiling the bibliometric data.

Disclaimer statements

Contributors All authors were actively involved in the study. ROS initiated and led the study. TL, TS, RS, EP, AN and AE were involved in planning, performing and analysing the study.

Funding This study was funded by the German Statutory Accident Insurance (DGUV, registration number FR 182 ukb).

Conflicts of interest All authors declare that they have no financial or professional conflicts of interest.

Ethics approval The study was approved by the Charité ethics committee (EA1/211/10) in December 2010. The study was performed in accordance with the criteria set out in the Declaration of Helsinki.