Capdevila Mathieu, De Jong Audrey, Belafia Fouad, Vonarb Aurelie, Carr Julie, Molinari Nicolas, Choquet Olivier, Capdevila Xavier, Jaber Samir
Department of Anesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, Montpellier, France; INSERM U1046, Montpellier, France.
Department of Anesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, Montpellier, France.
Anesthesiology. 2025 Mar 1;142(3):522-531. doi: 10.1097/ALN.0000000000005267. Epub 2024 Oct 21.
Diaphragm dysfunction is common in intensive care unit and associated with weaning failure and mortality. The diagnosis gold standard is the transdiaphragmatic or tracheal pressure induced by magnetic phrenic nerve stimulation. However, the equipment is not commonly available and requires specific technical skills. This study aimed to evaluate ultrasound-guided transcutaneous phrenic nerve stimulation for daily bedside assessment of diaphragm function by targeted electrical phrenic nerve stimulation.
This randomized crossover study compared a new method of ultrasound-guided transcutaneous electrical phrenic nerve stimulation (SONOTEPS) using a peripheral nerve stimulator, with magnetic phrenic nerve stimulation. Intensive care unit adult patients under mechanical ventilation with a Richmond Agitation-Sedation Scale score of -4 or -5 were included. Each patient received the two methods of stimulation, in a randomized order. The primary outcome was the tracheal pressure induced by stimulation.
This study analyzed 232 measures of tracheal pressure from 116 patients, of whom 77 presented diaphragm dysfunction (tracheal pressure less than 11 cm H 2 O) and 50 presented severe diaphragm dysfunction (tracheal pressure less than 8 cm H 2 O). The Passing-Bablok regression showed no significant differences (intercept A of -0.03 [95% CI, -0.83 to 0.52] and slope B of 0.98 [95% CI, 0.90 to 1.05]) between the SONOTEPS method and magnetic stimulation, which were positively correlated ( R ² = 0.639). The mean bias was -1.08 (95% CI, 5.02 to -7.18) cm H 2 O. The receiver operating curves showed an excellent performance for the diagnosis of diaphragm dysfunction and severe diaphragm dysfunction with areas under the curve of 0.90 (95% CI, 0.83 to 0.97) and 0.88 (95% CI, 0.82 to 0.95), respectively. This performance was not significantly affected by the body mass index or the presence of a neck catheter.
The SONOTEPS method is a simple and accurate tool for bedside assessment of diaphragm function with ultrasound-guided transcutaneous phrenic nerve stimulation in sedated patients with no or minimal spontaneous respiratory activity.
膈肌功能障碍在重症监护病房很常见，与撤机失败和死亡率相关。诊断的金标准是磁刺激膈神经诱导的跨膈压或气管压。然而，该设备并不常用，且需要特定的技术技能。本研究旨在评估超声引导下经皮膈神经刺激用于通过靶向电刺激膈神经对膈肌功能进行每日床边评估。
这项随机交叉研究将一种使用外周神经刺激器的超声引导下经皮膈神经电刺激新方法（SONOTEPS）与磁刺激膈神经进行了比较。纳入了机械通气下Richmond躁动镇静量表评分为-4或-5的重症监护病房成年患者。每位患者按随机顺序接受两种刺激方法。主要结局是刺激诱导的气管压。
本研究分析了116例患者的232次气管压测量值，其中77例存在膈肌功能障碍（气管压小于11 cmH₂O），50例存在严重膈肌功能障碍（气管压小于8 cmH₂O）。Passing-Bablok回归显示SONOTEPS方法与磁刺激之间无显著差异（截距A为-0.03 [95%CI，-0.83至0.52]，斜率B为0.98 [95%CI，0.90至1.05]），二者呈正相关（R² = 0.639）。平均偏差为-1.08（95%CI，5.02至-7.18）cmH₂O。受试者工作曲线显示，诊断膈肌功能障碍和严重膈肌功能障碍的性能极佳，曲线下面积分别为0.90（95%CI，0.83至0.97）和0.88（95%CI，0.82至0.95）。该性能不受体重指数或颈部导管的影响。
SONOTEPS方法是一种简单且准确的工具，用于在无自主呼吸活动或自主呼吸活动极少的镇静患者中，通过超声引导下经皮膈神经刺激对膈肌功能进行床边评估。
