Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
Acad Emerg Med. 2012 Apr;19(4):421-9. doi: 10.1111/j.1553-2712.2012.01329.x.
This study assessed the feasibility of an investigational vagus nerve stimulation (VNS) device for treating acute asthma exacerbations in patients not responding to at least 1 hour of initial standard care therapy.
This was a prospective, nonrandomized study of patients treated in the ED for moderate to severe acute asthma (forced expiratory volume in 1 second [FEV(1)] 25% to 70% of predicted). Treatment entailed percutaneous placement of an electrode near the right carotid sheath and 60 minutes of VNS and continued standard care. VNS voltage was adjusted to perceived improvement, muscle twitching, or adverse events (AEs). All AEs, vital signs, FEV(1), perceived work of breathing (WOB), and final disposition were recorded.
Twenty-five subjects were enrolled. There were no serious AEs and no significant changes in vital signs. No subject required terminating VNS. One patient had minor bleeding from the procedure, and one had a hematoma and withdrew prior to VNS. AEs related to VNS were temporary and included cough (1 of 24), swallowing difficulty (2 of 24), voice change (2 of 24), and muscle twitching (14 of 24). These resolved when VNS ended. The FEV(1) improved at 15 minutes (median = 15.8%, 95% confidence interval [CI] = 9.3% to 22.4%), 30 minutes (median = 21.3%, 95% CI = 8.1% to 36.5%), and 60 minutes (median = 27.5%, 95% CI = 11.3% to 43.5%). WOB improved at 15 minutes (median = 53.9%, 95% CI = 33.7% to 73.9%), 30 minutes (median = 69.1%, 95% CI = 56.4% to 81.8%), and 60 minutes (median = 81.0%, 95% CI = 68.5% to 93.5%).
Percutaneous VNS did not result in serious AEs and was associated with improvements in FEV(1) and perceived dyspnea. Percutaneous VNS appears to be feasible for use in the treatment of moderate to severe acute asthma in patients unresponsive to initial standard care treatment.
本研究评估了一种研究性迷走神经刺激（VNS）设备治疗初始标准治疗至少 1 小时后无反应的急性哮喘发作患者的可行性。
这是一项针对急诊科中度至重度急性哮喘（第 1 秒用力呼气量 [FEV1] 25%至 70%预计值）患者的前瞻性、非随机研究。治疗包括经皮将电极放置在右颈动脉鞘附近，并进行 60 分钟的 VNS 和持续的标准治疗。VNS 电压根据感知到的改善、肌肉抽搐或不良事件（AE）进行调整。记录所有 AE、生命体征、FEV1、感知呼吸做功（WOB）和最终处置。
共纳入 25 例患者。无严重 AE，生命体征无明显变化。没有患者需要终止 VNS。1 例患者出现手术部位轻微出血，1 例患者出现血肿并在 VNS 前退出。与 VNS 相关的 AE 是暂时的，包括咳嗽（24 例中的 1 例）、吞咽困难（24 例中的 2 例）、声音改变（24 例中的 2 例）和肌肉抽搐（24 例中的 14 例）。当 VNS 结束时，这些都得到了缓解。FEV1 在 15 分钟时改善（中位数=15.8%，95%置信区间[CI]=9.3%至 22.4%），在 30 分钟时改善（中位数=21.3%，95%CI=8.1%至 36.5%），在 60 分钟时改善（中位数=27.5%，95%CI=11.3%至 43.5%）。WOB 在 15 分钟时改善（中位数=53.9%，95%CI=33.7%至 73.9%），在 30 分钟时改善（中位数=69.1%，95%CI=56.4%至 81.8%），在 60 分钟时改善（中位数=81.0%，95%CI=68.5%至 93.5%）。
经皮 VNS 未导致严重 AE，与 FEV1 和感知呼吸困难的改善相关。经皮 VNS 似乎可用于治疗初始标准治疗无反应的中重度急性哮喘患者。
