This study assessed the effectiveness of noninvasive electromagnetic phrenic nerve stimulation to prevent diaphragmatic dysfunction in prolonged weaning patients.
We conducted a randomized controlled trial of patients who had been ventilated for ≥ 21d and were in the process of weaning. The intervention group received 15-min bilateral transcutaneous NEPNS bid, using phrenic nerve ultrasound find the optimal stimulation position. Whereas the control group received standard care. The evaluation was based on ultrasound measurements of expiratory diaphragm thickness during spontaneous breathing trials from days 1 to 14 (or weaned) . We also measured Diaphragm thickening fraction, maximal inspiratory muscle pressure (MIP), and weaning time.
Fifty two patients were included and randomized using a 1:1 ratio. There was no difference in the mean thickness of expiratory diaphragm between two groups at baseline (1.8±3.59mm vs 1.7±3.26 mm, P=0.299). A decrease in diaphragm thickness was prevented by bilateral NEPNS (F=5.646, P=0.002) until day 14. Diaphragm thickening fraction was >20% at the SBT for 73% of participants in the NEPNS group and 54% of the control group. The difference was not statistically significant(P=0.150). MIP and weaning time were similar in the two groups.
Bilateral transcutaneous NEPNS has the benefit of preventing diaphragm atrophy during mechanical ventilation. NEPNS ventilation effectiveness needs further assessment.
Bilateral transcutaneous NEPNS can maintain the therapeutic effect between inspiratory muscle training sessions given by physical therapists.
prolonged weaning
mechanical ventilation
