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

Michal Soták, Karel Roubík, Tomáš Henlín, Tomáš Tyll, Michal Soták, Karel Roubík, Tomáš Henlín, Tomáš Tyll

Abstract

Background: 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. 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.

Methods: A 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.

Results: The 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).

Conclusions: Our 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://ichgcp.net/clinical-trials-registry/NCT03559933 ).

Keywords: Diaphragm atrophy; Phrenic nerve; Ultrasound; Weaning from mechanical ventilation.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Ultrasound linear probe orientation (a) and view of the diaphragm (b) identified as a 3-layer structure comprised of two hyperechoic lines representing the pleural and peritoneal membranes and a middle hypoechoic layer representing the diaphragm muscle itself
Fig. 2
Fig. 2
Ultrasound measurement of the right side of the diaphragm, linear probe, 10 MHz (a), measurement was made from the middle of the pleural line to the middle of the peritoneal line (b) detail
Fig. 3
Fig. 3
Increase in diaphragm thickness in the interventional group
Fig. 4
Fig. 4
Decrease in diaphragm thickness in the control group
Fig. 5
Fig. 5
Increase in diaphragm thickness after 48 hours with stimulation and its corresponding decrease after 48 hours in the control group (without stimulation) compared to baseline at hour 0

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