This randomized controlled trial enrolled 84 patients with post-stroke tracheotomy, allocated to an observation group (42 cases; 2 eliminated, 2 dropped out) or control group (42 cases; 5 eliminated). Both groups received routine treatment. The control group received swallowing electrical stimulation for 20 minutes per session. The observation group additionally received auricular electroacupuncture at Fei (lung, CO) and Yanhou (pharynx larynx, TG) points, using intermittent wave at 5 Hz and 1 mA, with needles retained for 20 minutes per session. Treatment was administered once daily, with 6 consecutive days of intervention followed by a 1-day interval, over 4 weeks.
The extubation success rate of the tracheotomy tube was 89.5% (34/38) in the observation group versus 59.5% (22/37) in the control group (P<0.01), and extubation time was shorter in the observation group (P<0.001). Involuntary cough peak flow (ICPF) increased in both groups after treatment (P<0.01), with greater gains in the observation group (P<0.01). Tracheal cough reflex grading scale (TCRGS) and Rosenbek penetration-aspiration scale (PAS) scores decreased in both groups and were lower in the observation group (P<0.01 and P<0.05, respectively). Pharyngeal transit time (PTT) shortened more in the observation group (P<0.01).
No obvious adverse reactions were reported in either group. The authors propose a mechanism involving auricular vagal activation, enhanced cough reflex, and improved swallowing. Limitations include the modest sample size, single-center design implied by the abstract, and lack of reported long-term follow-up beyond the treatment course. Generalizability to broader post-stroke tracheotomy populations remains to be established.
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OBJECTIVE: To observe the effect of auricular electroacupuncture on the success rate of tracheal extubation in patients undergoing tracheotomy after stroke, and to explore its potential neuromodulatory mechanism.
METHODS: A total of 84 patients with post-stroke tracheotomy were randomly divided into an observation group (42 cases, 2 cases were eliminated and 2 cases dropped out) and a control group (42 cases, 5 cases were eliminated). The routine treatment was administered in both groups. Additionally, swallowing electrical stimulation was operated, 20 min each session in the control group. In the observation group, the auricular electroacupuncture was supplemented at Fei (lung, CO) and Yanhou (pharynx larynx, TG), with intermittent wave, a frequency of 5 Hz and a current of 1 mA, and with needles retained for 20 min in each session. The treatment was administered once daily, and the duration of treatment was composed of 4 weeks at the interval of 1 day after 6 consecutive days of intervention in the two groups. The extubation success rate and extubation time of tracheotomy tube were compared between the two groups. Before and after treatment, the involuntary cough peak flow (ICPF), the score of tracheal cough reflex grading scale (TCRGS), pharyngeal transit time (PTT) and the score of Rosenbek penetration-aspiration scale (PAS) were observed, and the intervention safety was evaluated in the two groups.
RESULTS: The extubation success rate of tracheotomy tube was 89.5% (34/38) in the observation group, higher than that in the control group (59.5% [22/37], < 0.01); the extubation time of tracheotomy tube in the observation group was shorter than that in the control group (<0.001). After treatment, ICPF in both groups increased in comparison with that before treatment (<0.01), and ICPF in the observation group was higher when compared with the control group (<0.01). The scores of TCRGS and PAS in both groups decreased in comparison with those before treatment (<0.01, <0.05), and the scores in the observation group were lower than those in the control group (<0.01, <0.05). PTT in both groups was shortened in comparison with that before treatment (<0.01), and PTT in the observation group was shorter than that in the control group (<0.01). No obvious adverse reactions were reported in either group.
CONCLUSION: Auricular electroacupuncture can increase the extubation success rate of tracheotomy tube and shorten the extubation time in patients with post-stroke tracheotomy, which may be associated with activating the auricular vagus nerve, enhancing the cough reflex and improving swallowing function.
