Evaluation of electric phrenic nerve stimulation patterns for mechanical ventilation: a pilot study

Diaphragm atrophy is a common side effect of mechanical ventilation and results in prolonged weaning. Electric phrenic nerve stimulation presents a possibility to avoid diaphragm atrophy by keeping the diaphragm conditioned in sedated patients. There is a need of further investigation on how to set stimulation parameters to achieve sufficient ventilation. A prototype system is presented with a systematic evaluation for stimulation pattern adjustments. The main indicator for efficient stimulation was the tidal volume. The evaluation was performed in two pig models. As a major finding, the results for biphasic pulses were more consistent than for alternating pulses. The tidal volume increased for a range of pulse frequency and pulse width until reaching a plateau at 80-120 Hz and 0.15 ms. Furthermore, the generated tidal volume and the stimulation pulse frequency were significantly correlated (0.42-0.84, p < 0.001 ). The results show which stimulation parameter combinations generate the highest tidal volume. We established a guideline on how to set stimulation parameters. The guideline is helpful for future clinical applications of phrenic nerve stimulation.

Automated summary

Diaphragm atrophy is a common issue in mechanically ventilated patients, but electric phrenic nerve stimulation may help avoid it. However, the optimal stimulation parameters for sufficient ventilation need further investigation. A prototype system was evaluated, and the main indicator for efficient stimulation was found to be the tidal volume. The results provide a guideline for setting stimulation parameters and have implications for future clinical applications.