Feasibility of transesophageal phrenic nerve stimulation

BioMedical Engineering OnLine

Research

Olivier Scheidegger¹  Lukas Geisshuesler²  Sven Krause²  Thomas Niederhauser³  Elisa M. Kaufmann³  Andreas Haeberlin⁴ 

[1] Department Neurology, Bern University Hospital, University of Bern, Bern, Switzerland;Institute of Human Centered Engineering HuCE, Bern University of Applied Sciences, Biel, Switzerland;Institute of Human Centered Engineering HuCE, Bern University of Applied Sciences, Biel, Switzerland;Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland;Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland;Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland;

关键词: Phrenic nerve stimulation;    Diaphragm activation;    Critical care;    Esophageal catheter;    Intensive care unit;    Lung and diaphragm protective;    Transesophageal stimulation;    Ventilation induced diaphragmatic dysfunction;    Hospital mortality;   

DOI  :  10.1186/s12938-023-01071-5

 received in 2022-09-22, accepted in 2023-01-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundEvery year, more than 2.5 million critically ill patients in the ICU are dependent on mechanical ventilation. The positive pressure in the lungs generated by the ventilator keeps the diaphragm passive, which can lead to a loss of myofibers within a short time. To prevent ventilator-induced diaphragmatic dysfunction (VIDD), phrenic nerve stimulation may be used.ObjectiveThe goal of this study is to show the feasibility of transesophageal phrenic nerve stimulation (TEPNS). We hypothesize that selective phrenic nerve stimulation can efficiently activate the diaphragm with reduced co-stimulations.MethodsAn in vitro study in saline solution combined with anatomical findings was performed to investigate relevant stimulation parameters such as inter-electrode spacing, range to target site, or omnidirectional vs. sectioned electrodes. Subsequently, dedicated esophageal electrodes were inserted into a pig and single stimulation pulses were delivered simultaneously with mechanical ventilation. Various stimulation sites and response parameters such as transdiaphragmatic pressure or airway flow were analyzed to establish an appropriate stimulation setting.ResultsPhrenic nerve stimulation with esophageal electrodes has been demonstrated. With a current amplitude of 40 mA, similar response figures of the diaphragm activation as compared to conventional stimulation with needle electrodes at 10mA were observed. Directed electrodes best aligned with the phrenic nerve resulted in up to 16.9 % higher amplitude at the target site in vitro and up to 6 cmH20 higher transdiaphragmatic pressure in vivo as compared to omnidirectional electrodes. The activation efficiency was more sensitive to the stimulation level inside the esophagus than to the inter-electrode spacing. Most effective and selective stimulation was achieved at the level of rib 1 using sectioned electrodes 40 mm apart.ConclusionDirected transesophageal phrenic nerve stimulation with single stimuli enabled diaphragm activation. In the future, this method might keep the diaphragm active during, and even support, artificial ventilation. Meanwhile, dedicated sectioned electrodes could be integrated into gastric feeding tubes.

【 授权许可】

CC BY   
© The Author(s) 2023

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