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Abstract
Diaphragm inactivity during invasive mechanical ventilation leads to diaphragm atrophy and weakness, hemodynamic instability, and ventilatory heterogeneity. Absent respiratory drive and effort can, therefore, worsen injury to both lung and diaphragm and is a major cause of failure to wean. Phrenic nerve stimulation (PNS) can maintain controlled levels of diaphragm activity independent of intrinsic drive and as such may offer a promising approach to achieving lung and diaphragm protective ventilatory targets. Whereas PNS has an established role in the management of chronic respiratory failure, there is emerging interest in how its multisystem putative benefits may be temporarily harnessed in the management of invasively ventilated patients with acute respiratory failure.
Footnotes
- Correspondence: Ewan Goligher MD PhD, Toronto General Hospital, 585 University Avenue, 9-MaRS-9024, Toronto, ON, Canada, M5G 2N2. E-mail: ewan.goligher{at}uhn.ca
Dr Bassi is a full-time employee of Lungpacer Medical. Dr Goligher discloses relationships with the National Sanitarium Association, Lungpacer Medical, and STIMIT AG.
Dr Morris is supported by a research award from the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
A version of this paper was presented by Dr Goligher at the New Horizons Symposium: Changing Concepts in Mechanical Ventilation at AARC Congress 2022, held November 9–12, in New Orleans, Louisiana.
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