Non-invasive electromagnetic phrenic nerve stimulation in ICU Setting Key to Preventing Diaphragm Atrophy: CHEST

In original Research published in CHEST, researchers concluded that Bilateral transcutaneous non-invasive electromagnetic phrenic nerve stimulation (NEPNS) has proven to be a feasible option in the intensive care unit (ICU) setting, potentially offering the advantage of preventing diaphragm atrophy during mechanical ventilation. However, they added that further evaluation of NEPNS ventilation effectiveness is necessary.

This study evaluated the feasibility of using 15-minute bilateral transcutaneous neurostimulation (NEPNS) in patients intubated for at least 72 hours. The intervention group received NEPNS twice daily for 15 min, while the control group received standard care. The primary outcome measure was the time to find the optimal stimulation position, and the secondary endpoint assessed expiratory diaphragm thickness using ultrasound.

Key findings from the study are:

• The revised EU regulation mandated the reapproval of medical devices, prematurely halting the study. Eleven patients were enrolled, including five interventions and six controls.

• The time to find an adequate stimulation position was 23 seconds.

• The intervention twice daily was executed in 87% of cases, and 92% included a next-day catch-up session.

• Ventilation with 3-6ml/kgIBW was achieved in 43 % of stimulations with stimulation only and 62 % with additional pressure support.

• Bilateral NEPNS prevented the decrease in diaphragm thickness until day 10.

This study demonstrated the feasibility of bilateral transcutaneous NEPNS in critical care, with a successful deployment rate of 23 seconds and a high realization rate of over 90% of planned sessions. STIMIT AG, Biel, Switzerland, supported the study.

Reference:

Panelli A, Grimm AM, Krause S, Verfuß MA, Ulm B, Grunow JJ, Bartels HG, Carbon NM, Niederhauser T, Weber-Carstens S, Brochard L, Schaller SJ, Non-invasive electromagnetic phrenic nerve stimulation in critically ill patients – a feasibility study., CHEST (2024), doi https:// doi.org/10.1016/j.chest.2024.02.035.