Effectiveness of Transcutaneous NMES as an Adjunct for Swallowing Disorders in Tracheotomized Patients

Evaluation of the Effectiveness of Transcutaneous Neuromuscular Electrical Stimulation as an Adjunct to Standard Treatment for Swallowing Disorders in Tracheotomized Patients Following Prolonged Mechanical Ventilation Weaning

Dysphagia can reach a prevalence of up to 80% in intensive care patients. The implementation or prolonged presence of medical devices such as the intubation tube, tracheostomy, or nasogastric tube alters the physiology of swallowing and causes local injuries at several levels. Additionally, certain medical treatments impair swallowing physiology and the patient's alertness, further promoting the development of these disorders.

Management of dysphagia involves two main types of strategies: adaptive or compensatory maneuvers and rehabilitation techniques such as: performing praxis or swallowing exercises; physical stimulation (tactile or thermal); transcranial stimulation (electrical or magnetic); and finally, pharyngeal or transcutaneous electrical stimulation (NMES).

Patients hospitalized in intensive care often present with altered levels of alertness, asynchronous ventilation and swallowing, and reduced motor capabilities, making it difficult to perform techniques like praxis, food trials, or resistance swallowing exercises. NMES does not require active patient cooperation or the permanent presence of the therapist during the stimulation session, thus increasing the intensity of dysphagia rehabilitation and the early implementation of treatment in these patients, complementing conventional rehabilitation. Muscle and sensory stimulation through the application of NMES can help increase the strength of the muscles involved in swallowing and improve sensory capabilities. However, its effects have not yet been evaluated in tracheostomized patients undergoing weaning from prolonged mechanical ventilation.

Inclusion Criteria:

• Hospitalized in intensive care units, post-ICU rehabilitation, or weaning and rehabilitation services;
• Presence of a tracheostomy for more than 72 hours due to difficult mechanical ventilation weaning;
• Diagnosis of swallowing disorders (swallowing fiberoscopy);
• Patient aged at least 18 years at the time of inclusion;
• Affiliated to a social security scheme or beneficiary of such a scheme;
• Written, free and informed consent of the patient or their next of kin.

Exclusion Criteria:

• Contra- indication to cervical NMES;
• History of swallowing disorders;
• Patient with a spinal cord injury above C5 level;
• History of head and neck cancer;
• Person under legal protection measures;
• Patient under guardianship or conservatorship;
• Known pregnancy;
• Limitation of care.