Reduced diaphragmatic activity during mechanical ventilation can lead to diaphragmatic disuse atrophy, atelectasis, increased lung stress and strain, and hemodynamic impairment. This, in turn, may prolong the duration of mechanical ventilation, make weaning more difficult, and even increase mortality. Synchronizing phrenic nerve stimulation to promote diaphragmatic activity may prevent ventilator-induced lung injury and ventilator-induced diaphragm dysfunction, thereby improving patient outcomes. Surgically implanted phrenic nerve stimulation has been used in certain neurological disorders, but the effects of percutaneous non-invasive synchronized phrenic nerve stimulation in patients with ARDS undergoing mechanical ventilation remain unclear and require further investigation.
Mechanical ventilation is an important treatment for patients with acute hypoxemic respiratory failure (AHRF). However, reduced diaphragmatic activity during mechanical ventilation can lead to diaphragmatic disuse atrophy, atelectasis, increased lung stress and strain, and hemodynamic impairment. This, in turn, may prolong the duration of mechanical ventilation, make weaning more difficult, and even increase mortality in these patients. In patients with AHRF undergoing mechanical ventilation, maintaining moderate spontaneous breathing under lung and diaphragm protective ventilation remains challenging. Synchronizing phrenic nerve stimulation to promote diaphragmatic activity may prevent ventilator-induced lung injury (VILI) and ventilator-induced diaphragm dysfunction (VIDD), thereby improving patient outcomes. Surgically implanted phrenic nerve stimulation has been used in certain neurological disorders, but the effects of percutaneous non-invasive synchronized phrenic nerve stimulation in patients with acute respiratory distress syndrome (ARDS) undergoing mechanical ventilation remain unclear and require further investigation.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
10
non-invasive phrenic nerve stimulation
Zhongda Hospital, School of Medicine, Southeast University
Nanjing, Jiangsu, China
RECRUITINGFrequency of enough Tidal volume
Percentage of stimulated breaths above the cut-off target tidal volume (3-6 ml/kg ideal body weigh) out of the total number of stimulated breaths
Time frame: Procedure (from enrollment to extubation)
The speed of successful non-invasive electrical stimulation deployment
Time between first successful electrical phrenic stimulation and identification of the optimal stimulation locus in seconds
Time frame: Procedure (from enrollment to extubation)
Driving pressure
driving pressure was measured in the volume-controlled mode and calculated as the difference between plateau pressure and positive end-expiratory pressure
Time frame: Procedure (from enrollment to extubation)
Diaphragm thickening fraction
Diaphragm thickening fraction measured with ultrasound of the diaphragm.
Time frame: up to 28 days
Diaphragm excursion
Diaphragm excursion measured with ultrasound of the diaphragm.
Time frame: up to 28 days
Maximal inspiratory pressure (MIP)
MIP is measured by the mechanical ventilator during electromagnetic phrenic nerve stimulation.
Time frame: Procedure (from enrollment to extubation)
ventilation distribution
ventilation distribution was measured by EIT
Time frame: Procedure (from enrollment to extubation)
Respiratory system compliance
Respiratory system compliance is calculated as the ratio of tidal volume to the difference between plateau pressure and positive end-expiratory pressure.
Time frame: Procedure (from enrollment to extubation)
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