Prevention of Human Diaphragm Atrophy with Short  Periods of Electrical Stimulation

Ayas, Najib; McCool, F. Dennis; Gore, Rajesh; Lieberman, Steven L.; Brown, Robert

doi:10.1164/ajrccm.159.6.9806147

Cited by 73 publications

(41 citation statements)

References 8 publications

(7 reference statements)

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“…This fi nding is consistent with rapid atrophy of the diaphragm due to mandatory modes of mechanical ventilation that inactivate the diaphragm. 5,16,17 Total thickness loss may have been greater than we measured, as the decline may have already started before the patients' entry into our study 24 to 48 hours after intubation.…”

Section: Comparisonmentioning

confidence: 86%

Ultrasonographic Evaluation of Diaphragm Thickness During Mechanical Ventilation in Intensive Care Patients

Francis

Hoffer

Reynolds

2016

American Journal of Critical Care

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Background Mechanical ventilation is associated with atrophy and weakness of the diaphragm. Ultrasound is an easy noninvasive way to track changes in thickness of the diaphragm. Objective To validate ultrasound as a means of tracking thickness of the diaphragm in patients undergoing mechanical ventilation by evaluating interobserver and interoperator reliability and to collect initial data on the relationship of mode of ventilation to changes in the diaphragm. Methods Daily ultrasound images of the quadriceps and the right side of the diaphragm were acquired in 8 critically ill patients receiving various modes of mechanical ventilation. Thickness of the diaphragm and the quadriceps was measured, and changes with time were noted. Interoperator and interobserver reliability were measured. Results Intraclass correlation coefficients between operators and between observers for thickness of the diaphragm and quadriceps were greater than 0.95, indicating excellent interoperator and interobserver reliability. Patients receiving assist-control ventilation (n = 4) showed a mean decline in diaphragm thickness of 4.7% per day. Patients receiving pressure support ventilation (n = 8) showed a mean increase in diaphragm thickness of 1.5% per day. Quadriceps thickness declined in all participants (n = 8) at a mean rate of 2.0% per day. Conclusions Use of ultrasound to measure thickness of the diaphragm in 8 intensive care patients undergoing various modes of mechanical ventilation was feasible and yielded reproducible results. Ultrasound tracking of changes in thickness of the diaphragm in this small sample indicated that the thickness decreased during assist-control mode and increased during pressure support mode. (American Journal of Critical Care. 2016;25:e1-e8)

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Section: Comparisonmentioning

confidence: 86%

Ultrasonographic Evaluation of Diaphragm Thickness During Mechanical Ventilation in Intensive Care Patients

Francis

Hoffer

Reynolds

2016

American Journal of Critical Care

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“…25,26 Some reports indicate that pacing has potential to lead to phrenic nerve reinnervation as demonstrated by nerve conduction studies. 27 …”

Section: Indications For Diaphragm Pacingmentioning

confidence: 99%

“…12,36 Levine et al showed that as little as 18 hours on mechanical ventilation can lead to atrophy of the diaphragm with conversion of type I to less fatigue resistant type IIb muscle fibers. 27,[37][38][39] For these reasons, fulltime pacing systems support cannot be achieved immediately, but rather should be attempted in a systematic progression. Advancement of pacing time should be correlated with improvement in diaphragm strength and endurance.…”

Section: Transition From Mechanical Ventilation To Pacingmentioning

confidence: 99%

Functional Electrical Stimulation in Spinal Cord Injury Respiratory Care

Jarosz

Littlepage

Creasey

et al. 2012

Topics in Spinal Cord Injury Rehabilitation

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The management of chronic respiratory insufficiency and/or long-term inability to breathe independently has traditionally been via positive-pressure ventilation through a mechanical ventilator. Although life-sustaining, it is associated with limitations of function, lack of independence, decreased quality of life, sleep disturbance, and increased risk for infections. In addition, its mechanical and electronic complexity requires full understanding of the possible malfunctions by patients and caregivers. Ventilator-associated pneumonia, tracheal injury, and equipment malfunction account for common complications of prolonged ventilation, and respiratory infections are the most common cause of death in spinal cord-injured patients. The development of functional electric stimulation (FES) as an alternative to mechanical ventilation has been motivated by a goal to improve the quality of life of affected individuals. In this article, we will review the physiology, types, characteristics, risks and benefits, surgical techniques, and complications of the 2 commercially available FES strategies -phrenic nerve pacing (PNP) and diaphragm motor point pacing (DMPP).

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“…Although CMV can be too harmful to diaphragm muscle fibers, few studies have been developed aiming VIDD prevention 16,18,19 . Maybe diaphragmatic dysfunction could be decreased by spontaneous breathing.…”

Section: Ventilator-induced Diaphragmatic Dysfunction (Vidd)mentioning

confidence: 99%

Effects of controlled and pressure support mechanical ventilation on rat diaphragm muscle

Oliveira

Costa²,

Assis

et al. 2012

Acta Cir. Bras.

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PURPOSE:The objective of this study was to analyze the effects of Pressure Controlled Ventilation mode (PCV-C) and PSV mode in diaphragm muscle of rats. METHODS: Wistar rats (n=18) were randomly assigned to the control group or to receive 6 hours of PCV and PSV. After this period, animals were euthanized and their diaphragms were excised, frozen in liquid nitrogen and stored in at -80º C for further histomorphometric analysis. RESULTS: Results showed a 15% decrease in cross-sectional area of muscle fibers on the PCV-C group when compared to the control group (p<0.001) and by 10% when compared to the PSV group (p<0.05). Minor diameter was decreased in PCV-C group by 9% when compared with the control group (p<0.001) and by 6% when compared to the PSV group (p<0.05). When myonuclear area was analyzed, a 16% decrease was observed in the PCV-C group when compared to the PSV group (p<0.05). No significant difference between the groups was observed in myonuclear perimeter (p>0.05). CONCLUSION: Short-term controlled mechanical ventilation seems to lead to muscular atrophy in diaphragm fibers. The PSV mode may attenuate the effects of VIDD. Key words: Anatomy & Histology. Diaphragm. Tracheostomy. Rats, Wistar. RESUMO OBJETIVO:Avaliar os efeitos do modo ventilatório controlado por pressão controlada (PCV-C) e do modo PSV sobre o músculo diafragma de ratos. MÉTODOS: Ratos (n = 18) da linhagem Wistar foram distribuídos no grupo controle (RE) ou para receber AVM por 6 horas no modo PCV-C e no modo PSV. Após esse período, os animais foram eutanasiados, o diafragma retirado e encaminhado para a análise histológica e morfométrica. RESULTADOS: Os resultados revelaram uma redução da área das fibras musculares de 15% no grupo PCV-C em comparação ao controle (p<0,001) e de 10% quando comparado ao grupo PSV (p<0,05). Já com relação ao diâmetro menor observou-se uma redução de 9% do grupo PCV-C em comparação ao controle (p<0,001) e de 6% em relação ao grupo PSV (p<0,05). Quando avaliada a área dos mionúcleos, notou-se uma redução de 16% desse parâmetro no grupo PCV-C, comparado ao PSV (p<0,05). Não houve diferença significativa no perímetro dos mionúcleos entre os grupos estudados (p>0,05). CONCLUSÃO: O grupo PCV-C apresentou atrofia muscular em um período curto de ventilação mecânica. O modo PSV parece atenuar os efeitos da DDIV.

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Prevention of Human Diaphragm Atrophy with Short Periods of Electrical Stimulation

Cited by 73 publications

References 8 publications

Ultrasonographic Evaluation of Diaphragm Thickness During Mechanical Ventilation in Intensive Care Patients

Ultrasonographic Evaluation of Diaphragm Thickness During Mechanical Ventilation in Intensive Care Patients

Functional Electrical Stimulation in Spinal Cord Injury Respiratory Care

Effects of controlled and pressure support mechanical ventilation on rat diaphragm muscle

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