Phrenic nerve stimulation prevents diaphragm atrophy in patients with respiratory failure on mechanical ventilation

Michal Soták,Tomáš Henlín,Tomáš Tyll,Karel Roubík

doi:10.1186/s12890-021-01677-2

Abstract

BackgroundDiaphragm atrophy and dysfunction is a major problem among critically ill patients on mechanical ventilation. Ventilator-induced diaphragmatic dysfunction is thought to play a major role, resulting in a failure of weaning. Stimulation of the phrenic nerves and resulting diaphragm contraction could potentially prevent or treat this atrophy. The subject of this study is to determine the effectiveness of diaphragm stimulation in preventing atrophy by measuring changes in its thickness.MethodsA total of 12 patients in the intervention group and 10 patients in the control group were enrolled. Diaphragm thickness was measured by ultrasound in both groups at the beginning of study enrollment (hour 0), after 24 hours, and at study completion (hour 48). The obtained data were then statistically analyzed and both groups were compared.ResultsThe results showed that the baseline diaphragm thickness in the interventional group was (1.98 ± 0.52) mm and after 48 hours of phrenic nerve stimulation increased to (2.20 ± 0.45) mm (p=0.001). The baseline diaphragm thickness of (2.00 ± 0.33) mm decreased in the control group after 48 hours of mechanical ventilation to (1.72 ± 0.20) mm (p<0.001).ConclusionsOur study demonstrates that induced contraction of the diaphragm by pacing the phrenic nerve not only reduces the rate of its atrophy during mechanical ventilation but also leads to an increase in its thickness – the main determinant of the muscle strength required for spontaneous ventilation and successful ventilator weaning.Trial registration: The study was registered with ClinicalTrials.gov (18/06/2018, NCT03559933, https://clinicaltrials.gov/ct2/show/NCT03559933).

Highlights

Diaphragm atrophy and dysfunction is a major problem among critically ill patients on mechanical ventilation
Mechanical ventilation has a number of adverse effects such as ventilator-associated pneumonia [4], lung injuries [5, 6], and a recently widely studied issue known as ventilator-induced diaphragmatic dysfunction (VIDD) [7, 8]
Using this approach allowed comparison of the effect of electrical stimulation between patients by minimizing the influence of the natural variability in diaphragm thickness between patients

Summary

Introduction

Diaphragm atrophy and dysfunction is a major problem among critically ill patients on mechanical ventilation. Ventilator-induced diaphragmatic dysfunction is thought to play a major role, resulting in a failure of weaning. Mechanical ventilation (MV) is one of the most common forms of organ support routinely administered in the intensive care unit (ICU), with the proportion of patients requiring MV reaching up to 40% [1,2,3]. Among the methods for assessing the thickness of the diaphragm and its excursion during the respiratory cycle, ultrasonography has proved to be the most effective It is a non-invasive, accessible examination with the possibility of repeated measurements [22]

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