Diaphragm Pacing by Electrical Stimulation of the Phrenic Nerve

Neurosurgery ◽  
1985 ◽  
Vol 17 (6) ◽  
pp. 974-984 ◽  
Author(s):  
William W. L. Glenn ◽  
Mildred L. Phelps
Keyword(s):  
Electrical Stimulation ◽  
Phrenic Nerve ◽  
Neuromuscular Disorders ◽  
Ventilatory Support ◽  
Historical Review ◽  
Diaphragm Muscle ◽  
Diaphragm Pacing ◽  
Ventilatory Insufficiency ◽  
Phrenic Nerves ◽  
Stimulation Of

Abstract Sophisticated techniques for electrical stimulation of excitable tissue to treat neuromuscular disorders rationally have been developed over the past 3 decades. A historical review shows that electricity has been applied to the phrenic nerves to activate the diaphragm for some 200 years. Of the contemporary methods for stimulating the phrenic nerve in cases of ventilatory insufficiency, the authors prefer stimulation of the phrenic nerve in the thorax using a platinum ribbon electrode placed behind the nerve and an attached subcutancously implanted radiofrequency (RF) receiver inductively coupled to an external RF transmitter. Instructions are given for implanting the electrode-receiver assembly, emphasizing atraumatic handling of the phrenic nerve and strict aseptic techniques. Diaphragm pacing is conducted with low frequency electrical stimulation at a slow repetition (respiratory) rate to condition the diaphragm muscle against fatigue and maintain it fatigue-free. Candidates for diaphragm pacing are those with ventilatory insufficiency due to malfunction of the respiratory control center or interruption of the upper motor neurons of the phrenic nerve. In the Yale series, there were 77 patients treated by diaphragm pacing; 63 (82%) started before 1981 and thus were available for follow-up for at least 5 years; 33 (52%) were paced for 5 to 10 years, and 15 (24%) were paced for 10 to 16. Long term stimulation of the phrenic nerves to pace the diaphragm is an effective method of ventilatory support in selected cases

Response of the diaphragm muscle to electrical stimulation of the phrenic nerve

1983 ◽  
Vol 58 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Thomas E. Ciesielski ◽  
Yoshitaka Fukuda ◽  
William W. L. Glenn ◽  
Jack Gorfien ◽  
Kathryn Jeffery ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Phrenic Nerve ◽  
High Frequency ◽  
Low Frequency ◽  
Diaphragm Muscle ◽  
Diaphragm Pacing ◽  
Frequency Group ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation

✓ The histological, histochemical, and ultrastructural features of canine diaphragms subjected to pacing by high-frequency electrical stimulation (27 to 33 Hz) of the phrenic nerve are compared with unstimulated diaphragms and with diaphragms subjected to pacing by low-frequency stimulation (11 to 13 Hz). The high-frequency group showed a reduced tidal volume (fatigue) after long-term stimulation, and myopathic changes which included enlarged internal and sarcolemmal nuclei, ring fibers, moth-eaten fibers with irregular histochemical staining, core/targetoid fibers, and smearing and aggregation of Z-band material with electron microscopy. The low-frequency group did not develop a significant degree of fatigue or pathological changes, and showed histochemical evidence of transformation to fast-twitch (type II) fibers. Possible pathogenic mechanisms and their similarity to those in certain human neuromuscular diseases are discussed. The application of the findings resulting from high- and low-frequency stimulation to long-term diaphragm pacing in humans with chronic ventilatory insufficiency is also discussed.

Diaphragm Pacing as an Adjunct in Respiratory Insufficiency

Neurosurgery ◽  
1978 ◽  
Vol 2 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Ronald F. Young
Keyword(s):  
Electrical Stimulation ◽  
Case Report ◽  
Respiratory Insufficiency ◽  
Phrenic Nerve ◽  
Social Problems ◽  
Potential Usefulness ◽  
Mechanical Ventilator ◽  
Diaphragm Pacing ◽  
Neurosurgical Patients ◽  
Stimulation Of

Abstract Most neurosurgical patients with permanent partial or complete respiratory insufficiency are managed with a mechanical ventilator and tracheostomy. This method presents many medical, technical, emotional, and social problems. A case report is presented that illustrates the potential usefulness of electrical stimulation of the phrenic nerve (“diaphragm pacing”) as an alternate method of therapy for respiratory insufficiency. This paper outlines the indications for, methods of, and problems with such a system and is intended to make its availability more widely appreciated among neurosurgeons.

Activation of thalamic ventroposteriolateral neurons by phrenic nerve afferents in cats and rats

2003 ◽  
Vol 94 (1) ◽  
pp. 220-226 ◽  
Author(s):  
Weirong Zhang ◽  
Paul W. Davenport
Keyword(s):  
Electrical Stimulation ◽  
Somatosensory Cortex ◽  
Phrenic Nerve ◽  
Proprioceptive Information ◽  
Neural Responses ◽  
Afferent Stimulation ◽  
Physiological Conditions ◽  
Sensory Pathways ◽  
Increased Activity ◽  
Stimulation Of

It has been demonstrated that phrenic nerve afferents project to somatosensory cortex, yet the sensory pathways are still poorly understood. This study investigated the neural responses in the thalamic ventroposteriolateral (VPL) nucleus after phrenic afferent stimulation in cats and rats. Activation of VPL neurons was observed after electrical stimulation of the contralateral phrenic nerve. Direct mechanical stimulation of the diaphragm also elicited increased activity in the same VPL neurons that were activated by electrical stimulation of the phrenic nerve. Some VPL neurons responded to both phrenic afferent stimulation and shoulder probing. In rats, VPL neurons activated by inspiratory occlusion also responded to stimulation on phrenic afferents. These results demonstrate that phrenic afferents can reach the VPL thalamus under physiological conditions and support the hypothesis that the thalamic VPL nucleus functions as a relay for the conduction of proprioceptive information from the diaphragm to the contralateral somatosensory cortex.

Different effects of halothane on diaphragm and hindlimb muscle in rats

1987 ◽  
Vol 63 (5) ◽  
pp. 1757-1762 ◽  
Author(s):  
B. Dureuil ◽  
N. Viires ◽  
Y. Nivoche ◽  
M. Fiks ◽  
R. Pariente ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Phrenic Nerve ◽  
Muscle Function ◽  
Negative Inotropic Effect ◽  
Abdominal Pressure ◽  
Mechanically Ventilated ◽  
Diaphragmatic Muscle ◽  
Hindlimb Muscle ◽  
Supramaximal Stimulation ◽  
Stimulation Of

The effects of halothane administration on diaphragm and tibialis anterior (TA) muscle were investigated in 30 anesthetized mechanically ventilated rats. Diaphragmatic strength was assessed in 17 rats by measuring the abdominal pressure (Pab) generated during supramaximal stimulation of the intramuscular phrenic nerve endings at frequencies of 0.5, 30, and 100 Hz. Halothane was administered during 30 min at a constant minimum alveolar concentration (MAC): 0.5, 1, and 1.5 MAC in three groups of five rats. For each MAC, Pab was significantly reduced for all frequencies of stimulation except at 100 Hz during 0.5 MAC halothane exposure. The effects of halothane (0.5, 1, and 1.5 MAC) on diaphragmatic neuromuscular transmission were assessed in five other rats by measuring the integrated electrical activity of the diaphragm (Edi) during electrical stimulation of the phrenic nerve. No change in Edi was observed during halothane exposure. In five other rats TA contraction was studied by measuring the strength of isometric contraction of the muscle during electrical stimulation of its nerve supply at different frequencies (0.5, 30, and 100 Hz). Muscle function was unchanged during administration of halothane in a cumulative fashion from 0.5 to 1.5 MAC. These results demonstrate that halothane does not affect hindlimb muscle function, whereas it had a direct negative inotropic effect on rat diaphragmatic muscle.

Repetitive magnetic stimulation of the phrenic nerves for diaphragm conditioning: a normative study of feasibility and optimal settings

2011 ◽  
Vol 36 (6) ◽  
pp. 1001-1008 ◽  
Author(s):  
Dan Adler ◽  
Stewart B. Gottfried ◽  
Nathalie Bautin ◽  
Tomislav Mirkovic ◽  
Matthieu Schmidt ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Muscle Function ◽  
Healthy Subjects ◽  
Magnetic Stimulation ◽  
Normative Study ◽  
Transdiaphragmatic Pressure ◽  
Repetitive Magnetic Stimulation ◽  
Phrenic Nerves ◽  
Phrenic Stimulation ◽  
Stimulation Of

Electrical stimulation can enhance muscle function. We applied repetitive cervical magnetic phrenic stimulation (rCMS) to induce diaphragm contractions in 7 healthy subjects (800 ms trains; transdiaphragmatic pressure (Pdi) measurements; tolerance ratings). Each rCMS train produced a sustained diaphragm contraction. Sixty-five percent of the maximal available output at 15 Hz proved the best compromise between Pdi and discomfort with nonfatiguing contractions. rCMS appears feasible and should be investigated for diaphragm conditioning in appropriate clinical populations.

scholarly journals Evaluation of the Safety of Percutaneous Electrical Stimulation of the Phrenic and Femoral Nerves in a Chronic Porcine Model: A GLP Study

2020 ◽  
Author(s):  
John O’Mahony ◽  
Carlus Dingfelder ◽  
Igor Polyakov ◽  
Trace Jocewicz ◽  
Jennifer Mischke
Keyword(s):  
Electrical Stimulation ◽  
Porcine Model ◽  
Work Of Breathing ◽  
Animal Health ◽  
Femoral Nerve ◽  
Diaphragm Muscle ◽  
Study Endpoint ◽  
Diaphragm Pacing ◽  
Lead Placement ◽  
Histopathological Studies

ABSTRACTPurposeDiaphragm pacing has been proposed as a method to prevent ventilator-induced diaphragm dysfunction (VIDD) during mechanical ventilation (MV). The present study assessed the safety of lead deployment and control of diaphragm inspiratory work in synchrony with MV utilizing percutaneous electrical phrenic nerve stimulation (PEPNS) in a sedated and ventilated porcine model.MethodsThe ability to safely place PEPNS four-electrode leads near the femoral nerve using ultrasound visualization and electrical stimulation to guide lead placement using a through the needle (TTN) approach was assessed for 4 animals. The feasibility of using the PEPNS system to activate the diaphragm in synchrony with inspiration within a desired target Work of Breathing (WOB) between 0.3 and 0.7 joules/L over eight hours was tested using three of the four animals with the fourth used as a control. The ability to control WOB during inspiration was assessed for flow and pressure-controlled breaths using a flow and pressure sensor attached to the wye, the connector joining the inspiratory and expiratory limbs to the endotracheal tube. Overall health (moribundity) was assessed at baseline and throughout the study until Day 30 for the surviving animals. Gross pathology and histopathological studies were performed on the femoral nerves and diaphragm muscle tissue following termination of the animals at Day 30.ResultsThe lower bound estimate of the proportion of successful stimulation within the desired level of WOB was 95.1%, achieving the study endpoint. Triggering synchrony was statistically significant at <88ms (p<0.0001) with WOB able to be maintained between 0.3 and 0.7 joules/L. There was no evidence of tissue or nerve damage nor impact on overall animal health associated with lead placement or electrical stimulation.ConclusionThe PEPNS leads were found to be safe for their intended use and the PEPNS system met preestablished study endpoints for synchrony and stimulation efficacy.

Central GABAergic mechanisms are involved in apnea induced by SLN stimulation in piglets

2001 ◽  
Vol 90 (4) ◽  
pp. 1570-1576 ◽  
Author(s):  
Jalal M. Abu-Shaweesh ◽  
Ismail A. Dreshaj ◽  
Musa A. Haxhiu ◽  
Richard J. Martin
Keyword(s):  
Electrical Stimulation ◽  
Phrenic Nerve ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Receptor Blocker ◽  
Inspiratory Time ◽  
Before And After ◽  
Four Levels ◽  
Stimulation Of

Stimulation of the superior laryngeal nerve (SLN) results in apnea in animals of different species, the mechanism of which is not known. We studied the effect of the GABAA receptor blocker bicuculline, given intravenously and intracisternally, on apnea induced by SLN stimulation. Eighteen 5- to 10-day-old piglets were studied: bicuculline was administered intravenously to nine animals and intracisternally to nine animals. The animals were anesthetized and then decerebrated, vagotomized, ventilated, and paralyzed. The phrenic nerve responses to four levels of electrical SLN stimulation were measured before and after bicuculline. SLN stimulation caused a significant decrease in phrenic nerve amplitude, phrenic nerve frequency, minute phrenic activity, and inspiratory time ( P < 0.01) that was proportional to the level of electrical stimulation. Increased levels of stimulation were more likely to induce apnea during stimulation that often persisted beyond cessation of the stimulus. Bicuculline, administered intravenously or intracisternally, decreased the SLN stimulation-induced decrease in phrenic nerve amplitude, minute phrenic activity, and phrenic nerve frequency ( P < 0.05). Bicuculline also reduced SLN-induced apnea and duration of poststimulation apnea ( P < 0.05). We conclude that centrally mediated GABAergic pathways are involved in laryngeal stimulation-induced apnea.

Diaphragm Pacing in Spinal Muscular Atrophy

Neurosurgery ◽  
1981 ◽  
Vol 9 (3) ◽  
pp. 317-319 ◽  
Author(s):  
Robert R. Richardson ◽  
Bruce Roseman ◽  
Naunihal Singh
Keyword(s):  
Spinal Muscular Atrophy ◽  
Muscular Atrophy ◽  
Ventilatory Support ◽  
Diaphragm Pacing ◽  
Electrode Recording ◽  
Transcutaneous Stimulation ◽  
Alveolar Hypoventilation ◽  
Phrenic Nerves ◽  
Psychological Improvement ◽  
Pulmonary Status

Abstract A patient with a diagnosis of intermediate or benign spinal muscular atrophy was severely incapacitated from respiratory complications and alveolar hypoventilation and was confined to mechanical ventilatory support. After extensive diagnostic evaluation of her pulmonary status, including transcutaneous stimulation of the phrenic nerves associated with nasogastric and surface electrode recording of the diaphragmatic response, this patient had a phrenic neurostimulation system implanted bilaterally for diaphragm pacing. Although spinal muscular atrophy has not been previously recognized as an indication for diaphragm pacing, her subsequent social, physical, and psychological improvement indicate that it may be significantly beneficial in selected cases of alveolar hypoventilation due to spinal muscular atrophy or neuromuscular disease.

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