Activation of Inspiratory Muscles via Spinal Cord Stimulation

Respir Physiol Neurobiol, 2013 · DOI: 10.1016/j.resp.2013.06.001 · Published: November 1, 2013

Simple Explanation

This paper explores a new method of activating inspiratory muscles using high-frequency electrical stimulation of the upper thoracic spinal cord. Unlike current diaphragm pacing, this technique activates inspiratory motoneuron pools, leading to more natural inspiratory muscle activation and simultaneous activation of the diaphragm and intercostal muscles. The preliminary results suggest that high-frequency spinal cord stimulation (HF-SCS) could be a more effective method for inspiratory muscle pacing.

Study Duration

Not specified

Participants

Animal model (dogs)

Evidence Level

Not specified

Key Findings

1
High-frequency spinal cord stimulation (HF-SCS) results in synchronous activation of both the diaphragm and inspiratory intercostal muscles in an animal model.
2
HF-SCS produces an asynchronous pattern of EMG activity and mean peak firing frequencies similar to those observed during spontaneous breathing.
3
Ventilation can be maintained on a long-term basis with repetitive stimulation at low stimulus amplitudes (<1 mA).

Research Summary

The paper reviews a novel method of inspiratory muscle activation using high-frequency (300 Hz) electrical stimulation on the ventral surface of the upper thoracic spinal cord. Unlike previous methods, this technique activates inspiratory motoneuron pools, resulting in more physiological activation of inspiratory muscles and simultaneous activation of the diaphragm and inspiratory intercostal muscles. Studies show that HF-SCS results in an asynchronous pattern of inspiratory EMG activity resembling spontaneous breathing, suggesting a more physiologic form of inspiratory muscle activation.

Practical Implications

Improved Inspiratory Muscle Pacing

HF-SCS could potentially offer a more successful method of inspiratory muscle pacing, especially for patients who do not respond well to conventional diaphragm pacing.

Physiologic Muscle Activation

The technique mimics natural breathing patterns, potentially reducing muscle fatigue and improving patient comfort.

Alternative for Phrenic Nerve Damage

HF-SCS of the intercostal muscles alone to provide complete ventilatory support has also been studied in patients with damage to their phrenic nerves.

Study Limitations

1
All studies related to HF-SCS were performed in dogs anesthetized with pentobarbital sodium.
2
Further animal testing and ultimately clinical trials will be necessary to determine the applicability of this method in the SCI population.
3
The impact of DP, compared to mechanical ventilation, on long-term survival is unknown.

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