The Application of Temporary Transvenous Diaphragm Neurostimulation As A Ventilatory Adjunct Is A Viable Diaphragm-Protective Strategy Against Ventilator-Induced Injury

This thesis explores the potential of phrenic nerve stimulation (PNS) as a therapeutic approach to mitigate ventilator-induced diaphragm dysfunction (VIDD) by preserving natural diaphragmatic activity during mechanical ventilation (MV). It involves a thorough examination of a PNS device used concurrently with MV and its effects on the development and progression of VIDD. This PNS system is designed to synchronize diaphragm contraction harmoniously with MV, with the aim to safeguard the diaphragm from ventilator-induced changes such as atrophy. By neurostimulating the diaphragm in this manner, the study established PNS as a promising countermeasure against the negative consequences of MV.

The thesis uses a well-studied animal model to show the safety and viability of using PNS to bilaterally contract the diaphragm for 50 hours in sync with MV. It offers findings that strongly support the use of PNS in conjunction with lung-protective ventilation as a diaphragm-protective strategy. The thesis also reports on the exploration of various stimulation regimes delivered by PNS and an assessment of their impact on the diaphragm, thus expanding PNS’s potential application as a solution for diaphragm and lung-protective ventilation.

It is proposed that PNS could represent a paradigm shift in MV therapy by reducing muscle damage and atrophy across all myofiber types while preserving the overall muscle composition. The importance of maintaining diaphragm function and advancing our understanding of PNS as a complementary therapy for MV is emphasized by the findings of this thesis. When judiciously applied, this innovative approach has the potential to protect the diaphragm from the detrimental effects of prolonged MV, ultimately, reducing patient morbidity, mortality, and dependency on MV.

In conclusion, this thesis presents promising prospects for improving patient outcomes in MV by emphasizing the importance of PNS in protecting the diaphragm. By addressing the critical issue of VIDD, the findings underscores the potential benefits of PNS in enhancing respiratory care and patient well-being while in critical care settings.