Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

French Ministry of Health and the Société Française d'Anesthésie Réanimation.

Impact of the research: Although bilateral phrenic nerve stimulation did not increase the proportion of successful weaning from mechanical ventilation compared to the standard of care, it resulted in substantial improvements in inspiratory pressure generation capacity without major safety issues. In the absence of previous clinical data, these findings suggest that diaphragm pacing could be effective in mitigating diaphragm dysfunction in patients difficult to wean from mechanical ventilation. Author contributions:The academic authors (MD, MGDA, TS) wrote the first draft of the manuscript and verified the underlying data. All authors critically reviewed and approved the manuscript and are accountable its accuracy and integrity. Dr Martin Dres had full access to all the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis. Teresa Nelson conducted and is responsible for the data analysis. Support:The study was funded by Lungpacer Medical Inc, PA, USA.