For a study, it was determined that diaphragm dysfunction was common in critically ill patients who had trouble weaning off of artificial ventilation. This study determined how transient transvenous diaphragm neurostimulation affected weaning and maximal inspiratory pressure. Randomized, controlled, multicentre, open-label trial. Patients aged 18 years who had been on invasive mechanical ventilation for 4 days and had failed two efforts at weaning were given temporary transvenous diaphragm neurostimulation (bilateral phrenic stimulation) by researchers and standard of care (treatment) (N=57) or standard of care (control) (N=55). They cannot place the catheters in seven patients, and pacing therapy could not be administered in seven patients, leaving 43 patients without data. They effectively weaned the proportion of patients who were the primary outcome. The other goals were mechanical breathing duration, 30-day survival, maximal inspiratory pressure, diaphragm thickening fraction, adverse events, and stimulation-related pain. Weaning success rates were 82% in the treatment group and 74% in the control group (absolute difference [95% CI]: 7% [-10,25], P=0.59). The duration of mechanical ventilation (mean standard deviation) was 12.7±9.9 days and 14.1±10.8 days (P=0.50); maximal inspiratory pressure increased by 16.6 cm H2O and 4.8 cm H2O (difference [95 % CI] 11.8 [5, 19] P=0.001); right hemidiaphragm thickening fraction during unassisted spontaneous breathing was +17 % and -14 % (P=0.006), with no correlation with changes in maximal inspiratory.
The frequency of serious adverse events was similar in both groups. The median stimulation-related pain was 0 in the therapy group. Temporary transvenous diaphragm neurostimulation did not improve the percentage of people who could successfully wean off of mechanical ventilation. It was linked to a considerable rise in maximal inspiratory pressure, suggesting a reversal of diaphragm dysfunction.
Reference:www.atsjournals.org/doi/abs/10.1164/rccm.202107-1709OC
