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Cited by 30Respiratory Support and MechanismsTranscranial Magnetic Stimulation StudiesCOVID-19 Clinical Research Studies

Efficacy and safety of HD-tDCS and respiratory rehabilitation for critically ill patients with COVID-19 the HD-RECOVERY randomized clinical trial

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Andrade, Suellen Marinho, Cecília de Araújo Silvestre, Maria, Tenório de França, Eduardo Ériko, Bezerra Sales Queiroz, Maria Heloísa, de Jesus Santana, Kelly, Lima Holmes Madruga, Marcela Lais, Torres Teixeira Mendes, Cristina Katya, Araújo de Oliveira, Eliane +17 more·2022·Brain Stimulation
DOI 10.1016/j.brs.2022.05.006PMC PMC9093082
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Abstract

BACKGROUND AND PURPOSE: Acute Respiratory Distress Syndrome (ADRS) due to coronavirus disease 2019 (COVID-19) has been associated with muscle fatigue, corticospinal pathways dysfunction, and mortality. High-Definition transcranial Direct Current Stimulation (HD-tDCS) may be used to attenuate clinical impairment in these patients. The HD-RECOVERY randomized clinical trial was conducted to evaluate the efficacy and safety of HD-tDCS with respiratory rehabilitation in patients with moderate to severe ARDS due to COVID-19. METHODS: Fifty-six critically ill patients were randomized 1:1 to active (n = 28) or sham (n = 28) HD-tDCS (twice a day, 30-min, 3-mA) plus respiratory rehabilitation for up to 10 days or until intensive care unit discharge. The primary outcome was ventilator-free days during the first 28 days, defined as the number of days free from mechanical ventilation. Furthermore, secondary outcomes such as delirium, organ failure, hospital length of stay and adverse effects were investigated. RESULTS: Active HD-tDCS induced more ventilator-free days compared to sham HD-tDCS. Patients in the active group vs in the sham group experienced lower organ dysfunction, delirium, and length of stay rates over time. In addition, positive clinical response was higher in the active vs sham group. There was no significant difference in the prespecified secondary outcomes at 5 days. Adverse events were similar between groups. CONCLUSIONS: Among patients with COVID-19 and moderate to severe ARDS, use of active HD-tDCS compared with sham HD-tDCS plus respiratory rehabilitation resulted in a statistically significant increase in the number of ventilator-free days over 28 days. HD-tDCS combined with concurrent rehabilitation therapy is a safe, feasible, potentially add-on intervention, and further trials should examine HD-tDCS efficacy in a larger sample of patients with COVID-19 and severe hypoxemia.

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Authors
Andrade, S. M., Cecília de Araújo Silvestre, M., Tenório de França, E. É., Bezerra Sales Queiroz, M. H., de Jesus Santana, K., Lima Holmes Madruga, M. L., Torres Teixeira Mendes, C. K., Araújo de Oliveira, E., Bezerra, J. F., Barreto, R. G., Alves Fernandes da Silva, S. M., Alves de Sousa, T., Medeiros de Sousa, W. C., Patrícia da Silva, M., Cintra Ribeiro, V. M., Lucena, P., Beltrammi, D., Catharino, R. R., Caparelli-Dáquer, E., Hampstead, B. M., Datta, A., Teixeira, A. L., Fernández-Calvo, B., Sato, J. R., & Bikson, M.
Affiliations
  • Universidade Federal da Paraíba (BR)
  • Governo do Estado de Paraíba (BR)
  • Universidade Estadual de Campinas (UNICAMP) (BR)
  • Universidade do Estado do Rio de Janeiro (BR)
  • University of Michigan (US)
  • City College of New York (US)
  • Universidade Federal do ABC (BR)
Corresponding author
Andrade, Suellen Marinho
ORCID
Venue
Brain Stimulation
Publisher
Elsevier BV
Published
2022-05
Volume
15
Issue
3
Pages
780-788
ISSN
  • 1876-4754 (ISSN-L)
  • 1935-861X
DOI
10.1016/j.brs.2022.05.006
PMC
PMC9093082
OpenAlex
W4280607765
Cited by
30
References
4
Citations by year
2026: 5 · 2025: 7 · 2024: 11 · 2023: 6 · 2021: 1
FWCI
3.87
Type
journal article
Language
en
Open access
Licence
Locations
  • Brain stimulation (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • RISalud Institutional Health Repository of Andalucía (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • National Institutes of Health
  • National Institute of Neurological Disorders and Stroke (R01NS112996, R01NS101362)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
Keywords
high-definition transcranial direct current stimulation, acute respiratory distress syndrome, COVID-19 pandemic, pulmonary rehabilitation, ventilator-free days, mechanical ventilation, delirium, organ dysfunction, critically ill patients, muscle fatigue, non-invasive brain stimulation
MeSH terms
COVID-19, SARS-CoV-2, Delirium, Humans, Respiratory Distress Syndrome, Critical Illness, Transcranial Direct Current Stimulation

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