Nearly half (47%) of patients with mechanical ventilation in the intensive care unit report having dyspnea. This respiratory distress, with a feeling of "thirst for air", often reaches unbearable limits and is a major factor in the deterioration of the quality of life and the prognosis of patients. Physiopathological mechanisms of dyspnea are beginning better understood and have analogies with those of pain. Like pain, dyspnea often persists despite appropriate treatment of the cause, because of perceptual dysfunction related to changes in cortical excitability and neuronal plasticity and requires specific treatments. Studies have shown that Transcranial Stimulation by low Current (tDCS) was able to modulate the perception of acute pain induced and chronic pain. The tDCS modulates the functioning of a whole set of brain structures including the anterior cingulate gyrus, the prefrontal cortex, the thalamus and the brain stem, some of which have an established role in the central integration of pain and dyspnea. The investigators have recently demonstrated that the application of tDCS on the primary cortical motor area reduces the excitability of the central neurological pathways dedicated to the respiratory muscles in healthy subjects. The investigators therefore hypothesize that tDCS could relieve dyspnea in intensive care. In this research project, the investigators propose to evaluate the efficiency of tDCS on dyspnea in patients admitted to intensive care unit, having sepsis and mechanically ventilated.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
63
A tDCS (Low Current Transcranial Stimulation) device with two electrodes: active and reference, will be used. The tDCS will be applied next to the cortical representation zone of the primary motor cortex and left pre-motor for 30 minutes; placebo (dummy stimulation), according to the patient's randomization arm.
A tDCS (Low Current Transcranial Stimulation) device with two electrodes: active and reference, will be used. The tDCS will be applied next to the cortical representation zone of the primary motor cortex and left pre-motor for 30 minutes; intensity 2 mA, in anodal polarity, according to the patient's randomization arm.
A tDCS (Low Current Transcranial Stimulation) device with two electrodes: active and reference, will be used. The tDCS will be applied next to the cortical representation zone of the primary motor cortex and left pre-motor for 30 minutes; intensity 2 mA, in cathodal polarity, according to the patient's randomization arm.
Hôpital Raymond Poincaré
Garches, France
Differential of the Dyspnea
Assessing differential of the Dyspnea Multidimensional Profile (MPD-A1) Scale A1 (from 0 to 10): between before (30 min before) and after (30 min after) the use of tDCS. The scale name is " Multidimensional dyspnea profile". The A1 dimension will be used and measures affective dimensions unpleasantness and overall breathing discomfort. The minimum score is 0 ( neutral) and the maximum score is 10 (unbearable discomfort).
Time frame: 30 min
Differential of the QS
Assessing differentials of the QS of the Multidimensional Dyspnea Profile measured between before and after the tDCS (MPD-QS scales) between before (30 min before) and after (30 min after) the use of tDCS.
Time frame: 30 min
Differential of the A2 dimension
Assessing differentials of the sale A2 of the Multidimensional Dyspnea Profile measured between before and after the tDCS (MPD-A2 scales) between before (30 min before) and after (30 min after) the use of tDCS.
Time frame: 30 min
Differential of IC-RDOS
Differential of Diagnostic Accuracy of Respiratory Distress Observation Scales (IC-RDOS scale) between before (30 min before) and after (30 min after) the use of tDCS. Persichini, R., Gay, F., Schmidt, M., Mayaux, J., Demoule, A., Morélot-Panzini, C., \& Similowski, T. (2015). Diagnostic accuracy of respiratory distress observation scales as surrogates of dyspnea self-report in intensive care unit patients. Anesthesiology: The Journal of the American Society of Anesthesiologists, 123(4), 830-837.
Time frame: 30 min
Pre-inspiratory potentials (PIP)
Presence of possible PIP on Electroencephalography (EEG)
Time frame: 1 day
Death
Time frame: 28 days
Delirium
Cumulative incidence of delirium and its duration
Time frame: 28 days
Mechanical ventilation
Cumulative incidence of mechanical ventilation
Time frame: 28 days
ICU length of stay
Time frame: 28 days
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.