Diaphragm pacing: Evaluation of current waveforms for effective ventilation

Abstract

To evaluate the effectiveness of the configuration of the stimulating waveform on diaphragm pacing, we evaluated several different current forms: UDC-bipolar, UDC-monopolar cathodal, UDC-monopolar anodal, and ABDC. During stimulation with a pulse interval of 37 msec., a decrease in tidal volume was observed during the initial 30 hours with UDC-bipolar and UDC-monopolar anodal waveforms. Both UDC-monopolar cathodal and ABDC stimulation maintained the initial effectiveness for 6 hours. The decrease in tidal volume of UDC-monopolar anodal closely paralleled that of UDC-bipolar stimulation. Decreasing the pulse interval to 20 msec. caused a decrease in tidal volume with both UDC-monopolar cathodal and ABDC waveforms. Arterial oxygen tension (PaO2) in these experiments decreased to about 60 mm. Hg soon after the onset of unilateral diaphragm pacing. The concomitant decrease in tidal volume seen with UDC-bipolar stimulation could be avoided through the administration of oxygen to keep the animal's PaO2 about 100 mm. Hg. The amplitude of the evoked diaphragmatic action potentials decreased significantly under hypoxemia and returned to normal with hyperoxygenation. From these short-term experiments, our findings indicate that waveform configuration does influence the time of onset of diaphragm fatigue due to either an neuromuscular junction. Further, hypoxemia accelerates the occurrence of fatigue.