Dres, Martin and de Abreu, Marcelo Gama and Merdji, Hamid and Muller-Redetzky, Holger and Dellweg, Dominic and Randerath, Winfried J. and Mortaza, Satar and Jung, Boris and Bruells, Christian and Moerer, Onnen and Scharffenberg, Martin and Jaber, Samir and Besset, Sebastien and Bitter, Thomas and Geise, Arnim and Heine, Alexander and Malfertheiner, Maximilian and Kortgen, Andreas and Benzaquen, Jonathan and Nelson, Teresa and Uhrig, Alexander and Moenig, Olaf and Meziani, Ferhat and Demoule, Alexandre and Similowski, Thomas (2022) Randomized Clinical Study of Temporary Transvenous Phrenic Nerve Stimulation in Difficult-to-Wean Patients. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 205 (10). pp. 1169-1178. ISSN 1073-449X, 1535-4970
Full text not available from this repository. (Request a copy)Abstract
Rationale: Diaphragm dysfunction is frequently observed in critically ill patients with difficult weaning from mechanical ventilation. Objectives: To evaluate the effects of temporary transvenous diaphragm neurostimulation on weaning outcome and maximal inspiratory pressure. Methods: Multicenter, open-label, randomized, controlled study. Patients aged >= 18 years on invasive mechanical ventilation for >= 4 days and having failed at least two weaning attempts received temporary transvenous diaphragm neurostimulation using a multielectrode stimulating central venous catheter (bilateral phrenic stimulation) and standard of care (treatment) (n = 57) or standard of care (control) (n= 55). In seven patients, the catheter could not be inserted, and in seven others, pacing therapy could not be delivered; consequently, data were available for 43 patients. The primary outcome was the proportion of patients successfully weaned. Other endpoints were mechanical ventilation duration, 30-day survival, maximal inspiratory pressure, diaphragm-thickening fraction, adverse events, and stimulation-related pain. Measurements and Main Results: The incidences of successful weaning were 82% (treatment) and 74% (control) (absolute difference [95% confidence interval (CI)], 7% [-10 to 25]), P = 0.59. Mechanical ventilation duration (mean +/- SD) was 12.7 +/- 9.9 days and 14.1 +/- 10.8 days, respectively, P = 0.50; maximal inspiratory pressure increased by 16.6 cm H2O and 4.8 cm H2O, respectively (difference [95% CI], 11.8 [5 to 19]), P = 0.001; and right hemidiaphragm thickening fraction during unassisted spontaneous breathing was +17% and -14%, respectively, P = 0.006, without correlation with changes in maximal inspiratory pressure. Serious adverse event frequency was similar in both groups. Median stimulation-related pain in the treatment group was 0 (no pain). Conclusions: Temporary transvenous diaphragm neurostimulation did not increase the proportion of successful weaning from mechanical ventilation. It was associated with a significant increase in maximal inspiratory pressure, suggesting reversal of the course of diaphragm dysfunction.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MECHANICAL VENTILATION; INTENSIVE-CARE; DIAPHRAGM; MUSCLE; DYSFUNCTION; WEAKNESS; IMPACT; TRIAL; ICU; diaphragm weakness; weaning; mechanical ventilation; ventilator-induced diaphragmatic dysfunction |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 13 Dec 2023 07:19 |
| Last Modified: | 13 Dec 2023 07:19 |
| URI: | https://pred.uni-regensburg.de/id/eprint/58782 |
Actions (login required)
 |
View Item |
