Diaphragmatic neurostimulation in intensive care: techniques, feasibility, and potential indications

Abstract

Diaphragmatic neurostimulation is a muscle stimulation technique that, through electrodes placed directly on or near the phrenic nerves, enables diaphragmatic contractions independently of the subject's cooperation. Recently, the technical development of temporary diaphragmatic neurostimulation devices has heralded a new era in the management of intensive care patients. Combining positive pressure mechanical ventilation with diaphragmatic neurostimulation can limit or avoid well-known deleterious effects of positive pressure mechanical ventilation. Maintaining diaphragmatic contractile activity during ventilation could reduce the risk of diaphragmatic atrophy and dysfunction, decrease the risk of atelectasis, mitigate ventilator-induced lung injuries, and limit the drop in cardiac output under positive pressure ventilation. Furthermore, experimental evidence suggests that diaphragmatic neurostimulation could prevent ventilator-associated brain injuries. In this general review inspired by a recent publication from our group [1], we aim to describe the recent technical developments of diaphragmatic neurostimulation and its potentially associated physiological effects with clinical benefits for intensive care patients.