Effects of Abdominal Electrical Stimulation Combined With Airway Clearance Techniques in Tracheotomized Patients With Neurological Disorders: A Randomized, Controlled Trial

OBJECTIVES: This study aims to investigate the effects of combined abdominal electrical stimulation and airway clearance techniques on the primary outcome of decannulation success in tracheostomized patients with neurologic disorders. DESIGN: A randomized, assessor-blinded, controlled trial. SETTING: Department of Rehabilitation Medicine, Affiliated Hospital of Jining Medical University. PATIENTS: A total of 68 adult patients with neurologic disorders who had successfully weaned off mechanical ventilation but remained tracheostomized participated in this study. INTERVENTIONS: Airway clearance techniques with or without abdominal electrical stimulation therapy. MEASUREMENTS AND MAIN RESULTS: We randomized 68 patients into control (n = 34) and experimental (n = 34) groups. Both groups received a 6-week course of conventional treatment combined with airway clearance techniques. The experimental group additionally received abdominal electrical stimulation. The primary outcome was the decannulation success rate. Secondary outcomes assessed over 6 weeks included peak flow rate during nonvoluntary coughing, clinical pulmonary infection score, abdominal muscle thickness, and resting diaphragmatic mobility. At 6 weeks, the experimental group demonstrated significantly higher peak involuntary cough flow rate (mean difference, 39.433 L/min; 95% CI, 28.83-50.04; p < 0.001) and abdominal muscle thickness (difference, 0.106 cm; 95% CI, 0.08-0.13; p < 0.001) compared with the control. Furthermore, the decannulation success rate was significantly higher in the experimental group (93.3%) than that in the control group (73.3%; odds ratio, 5.070; 95% CI, 1.41-18.24; p = 0.013). However, no significant differences were observed between the two groups in clinical pulmonary infection scores (p > 0.05) or resting diaphragm mobility (p > 0.05). CONCLUSIONS: Adding abdominal electrical stimulation to airway clearance techniques significantly improves cough efficacy, increases abdominal muscle thickness, and enhances decannulation success in tracheostomized patients with neurologic disorders. However, it does not appear to alter infection control or resting diaphragmatic activity.