Phrenic nerve stimulation to prevent diaphragmatic dysfunction and ventilator-induced lung injury

Intensive Care Medicine Experimental, 2023 · DOI: https://doi.org/10.1186/s40635-023-00577-5 · Published: December 6, 2023

Critical Care Pulmonology

Simple Explanation

Mechanical ventilation, while life-saving, can lead to ventilator-induced diaphragmatic dysfunction (VIDD) and ventilator-induced lung injury (VILI). Phrenic nerve stimulation (PNS) is being explored as a way to counteract these side effects by strengthening the diaphragm and potentially reducing the need for high levels of mechanical ventilation. Different PNS techniques are being investigated, including invasive and non-invasive methods, to determine their effectiveness in improving diaphragm function and preventing lung injury in critically ill patients.

Study Duration

Not specified

Participants

Critically ill patients

Evidence Level

Review

Key Findings

1
Therapeutic PNS has been demonstrated as feasible and safe in lung-healthy and critically ill patients.
2
Increased inspiratory muscle strength and improved diaphragm activity indicate the potential of PNS for beneficial effects on clinical outcomes.
3
Non-invasive electromagnetic PNS suggests that the induced diaphragmatic contractions result in airway pressure swings and tidal volumes remaining within the thresholds of lung-protective mechanical ventilation.

Research Summary

This review analyzes the current evidence of phrenic nerve stimulation (PNS) for preventing diaphragm weakness and explores the potential protection against ventilator-induced lung injury (VILI) in critically ill patients. PNS-driven diaphragm contractions can generate adequate ventilation with low transpulmonary pressures, potentially reducing the risk of lung stress and VILI. While pilot results are promising, further studies with a high level of evidence are necessary to validate the potential benefits of PNS in critically ill patients.

Practical Implications

Diaphragm Training

PNS can be utilized as a method of diaphragm training to enhance muscle strength and function, potentially leading to improved weaning outcomes and reduced ICU stays.

VILI Prevention

PNS may offer a lung-protective ventilation strategy by reducing the duration or intensity of mechanical ventilation, thereby minimizing the risk of VILI.

Personalized Ventilation

Future research might focus on using PNS in combination with invasive and non-invasive assisted ventilation with automatic synchronization and the modulation of PNS with spontaneous breathing efforts.

Study Limitations

1
Lack of standardized PNS techniques.
2
Limited data, primarily from preclinical studies.
3
Need for studies with a high level of evidence to validate the potential benefits of PNS in critically ill patients.

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