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10-06-2022 | Nerve Stimulation | Special Issue Insight

Phrenic nerve stimulation to protect the diaphragm, lung, and brain during mechanical ventilation

Authors: Idunn S. Morris, Martin Dres, Ewan C. Goligher

Published in: Intensive Care Medicine | Issue 10/2022

Excerpt

Phrenic nerve stimulation (PNS) to elicit diaphragm contraction was first described over 200 years ago in the management of a case of neonatal asphyxia [1]. Since then the technique has developed significantly with established therapeutic indications for patients with high cervical cord injury or central sleep apnoea syndromes. Temporary PNS may offer potential physiological benefits for multiple organ systems and may prevent or treat diaphragm weakness in critically ill patients (Fig. 1). PNS can be delivered by multiple routes including direct surgical implantation of electrodes[2], or via transvenous[3], percutaneous[4] or transcutaneous[5] routes. …

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Dres M, de Abreu MG, Merdji H et al (2022) Randomised clinical study of temporary transvenous phrenic nerve stimulation in difficult-to-wean patients. Am J Resp Crit Care 205:1169–1178. https://doi.org/10.1164/rccm.202107-1709ocCrossRef

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Keogh C, Saavedra F, Dubo S et al (2022) Non-invasive phrenic nerve stimulation to avoid ventilator-induced diaphragm dysfunction in critical care. Artif Organs. https://doi.org/10.1111/aor.14244CrossRefPubMed

Goligher EC, Dres M, Fan E et al (2018) Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Resp Crit Care 197:204–213. https://doi.org/10.1164/rccm.201703-0536ocCrossRef

Masmoudi H, Coirault C, Demoule A et al (2013) Can phrenic stimulation protect the diaphragm from mechanical ventilation-induced damage? Eur Respir J 42:280–283. https://doi.org/10.1183/09031936.00045613CrossRefPubMed

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Reynolds SC, Meyyappan R, Thakkar V et al (2016) Mitigation of ventilator-induced diaphragm atrophy by transvenous phrenic nerve stimulation. Am J Resp Crit Care 195:339–348. https://doi.org/10.1164/rccm.201502-0363ocCrossRef

10.

Martin AD, Joseph A-M, Beaver TM et al (2014) Effect of intermittent phrenic nerve stimulation during cardiothoracic surgery on mitochondrial respiration in the human diaphragm&ast. Crit Care Med 42:e152–e156. https://doi.org/10.1097/ccm.0b013e3182a63fdfCrossRefPubMedPubMedCentral

11.

Rohrs EC, Bassi TG, Fernandez KC et al (2021) Diaphragm neurostimulation during mechanical ventilation reduces atelectasis and transpulmonary plateau pressure, preserving lung homogeneity and PaO2/FIO2. J Appl Physiol 131:290–301. https://doi.org/10.1152/japplphysiol.00119.2021CrossRefPubMed

12.

Masmoudi H, Persichini R, Cecchini J et al (2017) Corrective effect of diaphragm pacing on the decrease in cardiac output induced by positive pressure mechanical ventilation in anesthetized sheep. Respir Physiol Neurobiol 236:23–28. https://doi.org/10.1016/j.resp.2016.10.009CrossRefPubMed

13.

González-López A, López-Alonso I, Aguirre A et al (2013) Mechanical ventilation triggers hippocampal apoptosis by vagal and dopaminergic pathways. Am J Respir Crit Care 188:693–702. https://doi.org/10.1164/rccm.201304-0691ocCrossRef

14.

Bassi TG, Rohrs EC, Fernandez KC et al (2021) Transvenous diaphragm neurostimulation mitigates ventilation-associated brain injury. Am J Respir Crit Care 204:1391–1402. https://doi.org/10.1164/rccm.202101-0076ocCrossRef

15.

Lin M-C, Ebihara S, Dwairi QE et al (1998) Diaphragm sarcolemmal injury is induced by sepsis and alleviated by nitric oxide synthase inhibition. Am J Respir Crit Care 158:1656–1663. https://doi.org/10.1164/ajrccm.158.5.9803112CrossRef

Title: Phrenic nerve stimulation to protect the diaphragm, lung, and brain during mechanical ventilation
Authors: Idunn S. Morris
Martin Dres
Ewan C. Goligher
Publication date: 10-06-2022
Publisher: Springer Berlin Heidelberg
Keyword: Nerve Stimulation
Published in: Intensive Care Medicine / Issue 10/2022
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-022-06760-8

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Phrenic nerve stimulation to protect the diaphragm, lung, and brain during mechanical ventilation

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