Bassi Thiago, Rohrs E Elizabeth, Parfait Melodie, Hannigan Brett C, Reynolds Steven, Mayaux Julien, Decavèle Maxens, Herrero Jose, Demoule Alexandre, Similowski Thomas, Dres Martin
Lungpacer Medical Inc., Vancouver, BC, Canada.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Commun Med (Lond). 2024 Nov 18;4(1):235. doi: 10.1038/s43856-024-00662-0.
In critically ill patients, deep sedation and mechanical ventilation suppress the brain-diaphragm-lung axis and are associated with cognitive issues in survivors.
This exploratory crossover design study investigates whether phrenic nerve stimulation can enhance brain activity and connectivity in six deeply sedated, mechanically ventilated patients with acute respiratory distress syndrome.
Our findings indicate that adding phrenic stimulation on top of invasive mechanical ventilation in deeply sedated, critically ill, moderate acute respiratory distress syndrome patients increases cortical activity, connectivity, and synchronization in the frontal-temporal-parietal cortices.
Adding phrenic stimulation on top of invasive mechanical ventilation in deeply sedated, critically ill, moderate acute respiratory distress syndrome patients increases cortical activity, connectivity, and synchronization. The observed changes resemble those during diaphragmatic breathing in awake humans. These results suggest that phrenic nerve stimulation has the potential to restore the brain-diaphragm-lung crosstalk when it has been shut down or impaired by mechanical ventilation and sedation. Further research should evaluate the clinical significance of these results.
在重症患者中，深度镇静和机械通气会抑制脑-膈-肺轴，并与幸存者的认知问题相关。
这项探索性交叉设计研究调查了膈神经刺激是否能增强六名患有急性呼吸窘迫综合征的深度镇静、机械通气患者的大脑活动和连通性。
我们的研究结果表明，在深度镇静、重症、中度急性呼吸窘迫综合征患者的有创机械通气基础上加用膈神经刺激，可增加额颞顶叶皮质的皮质活动、连通性和同步性。
在深度镇静、重症、中度急性呼吸窘迫综合征患者的有创机械通气基础上加用膈神经刺激，可增加皮质活动、连通性和同步性。观察到的变化类似于清醒人类在膈式呼吸时的变化。这些结果表明，当膈神经刺激因机械通气和镇静而被阻断或受损时，它有可能恢复脑-膈-肺的相互作用。进一步的研究应评估这些结果的临床意义。
