Feasibility of transesophageal phrenic nerve stimulation

Kaufmann, Elisa Maria; Krause, Sven; Geisshüsler, Lukas; Scheidegger, Olivier; Haeberlin, Andreas; Niederhauser, Thomas (2023). Feasibility of transesophageal phrenic nerve stimulation BioMedical Engineering OnLine, 22(1) Springer Nature 10.1186/s12938-023-01071-5

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Background Every year, more than 2.5 million critically ill patients in the ICU are dependent on mechanical ventilation. The positive pressure in the lungs generated by the ventilator keeps the diaphragm passive, which can lead to a loss of myofibers within a short time. To prevent ventilator-induced diaphragmatic dysfunction (VIDD), phrenic nerve stimulation may be used. Objective The goal of this study is to show the feasibility of transesophageal phrenic nerve stimulation (TEPNS). We hypothesize that selective phrenic nerve stimulation can efficiently activate the diaphragm with reduced co-stimulations. Methods An in vitro study in saline solution combined with anatomical findings was performed to investigate relevant stimulation parameters such as inter-electrode spacing, range to target site, or omnidirectional vs. sectioned electrodes. Subsequently, dedicated esophageal electrodes were inserted into a pig and single stimulation pulses were delivered simultaneously with mechanical ventilation. Various stimulation sites and response parameters such as transdiaphragmatic pressure or airway flow were analyzed to establish an appropriate stimulation setting. Results Phrenic nerve stimulation with esophageal electrodes has been demonstrated. With a current amplitude of 40 mA, similar response figures of the diaphragm activation as compared to conventional stimulation with needle electrodes at 10mA were observed. Directed electrodes best aligned with the phrenic nerve resulted in up to 16.9 % higher amplitude at the target site in vitro and up to 6 cmH20 higher transdiaphragmatic pressure in vivo as compared to omnidirectional electrodes. The activation efficiency was more sensitive to the stimulation level inside the esophagus than to the inter-electrode spacing. Most effective and selective stimulation was achieved at the level of rib 1 using sectioned electrodes 40 mm apart. Conclusion Directed transesophageal phrenic nerve stimulation with single stimuli enabled diaphragm activation. In the future, this method might keep the diaphragm active during, and even support, artificial ventilation. Meanwhile, dedicated sectioned electrodes could be integrated into gastric feeding tubes.

Item Type:	Journal Article (Original Article)
Division/Institute:	School of Engineering and Computer Science > Institute for Human Centered Engineering (HUCE) School of Engineering and Computer Science > Institute for Human Centered Engineering (HUCE) > HUCE / Laboratory for Microelectronics and Medical Devices School of Engineering and Computer Science BFH Centres and strategic thematic fields > BFH centre for Health technologies
Name:	Kaufmann, Elisa Maria; Krause, Sven; Geisshüsler, Lukas; Scheidegger, Olivier; Haeberlin, Andreas and Niederhauser, Thomas0000-0003-2633-0844
Subjects:	R Medicine > R Medicine (General) T Technology > TK Electrical engineering. Electronics Nuclear engineering
ISSN:	1475-925X
Publisher:	Springer Nature
Funders:	[7] Swiss National Science Foundation
Language:	English
Submitter:	Thomas Niederhauser
Date Deposited:	08 Feb 2023 10:52
Last Modified:	12 Feb 2023 01:36
Publisher DOI:	10.1186/s12938-023-01071-5
Uncontrolled Keywords:	Phrenic nerve stimulation, Diaphragm activation, Critical care, Esophageal catheter, Intensive care unit, Lung and diaphragm protective, Transesophageal stimulation, Ventilation induced diaphragmatic dysfunction, Hospital mortality
ARBOR DOI:	10.24451/arbor.18820
URI:	https://arbor.bfh.ch/id/eprint/18820