Shen Yuliang, Wang Ting, Zhang Xiaohan, Shao Wei, Wang Yuhao, Kang Xiuwen, Gu Caihong, Li Yong, Mu Zhifang, Zhang Chenying, Hu Rong
Department of Respiratory and Critical Care Medicine, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222000, Jiangsu, China.
Department of Critical Care Medicine, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222000, Jiangsu, China.
Sci Rep. 2025 Jun 2;15(1):19340. doi: 10.1038/s41598-025-04352-2.
Diaphragm dysfunction, a prevalent complication in mechanically ventilated patients, is strongly associated with prolonged weaning periods and increased mortality rates. Neurally adjusted ventilatory assist (NAVA), which synchronizes ventilator support with neural respiratory drive through diaphragmatic electromyography monitoring, has demonstrated efficacy in preserving diaphragm contractility. Complementary to this, the external diaphragmatic pacing (EDP) mitigates ventilation-induced diaphragmatic atrophy through targeted phrenic nerve stimulation. However, the synergistic potential of the NAVA + EDP combination therapy in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains unexplored. This prospective randomized trial enrolled 60 mechanically ventilated patients with AECOPD, who were equally allocated into three groups (n = 20 per group): conventional pressure support ventilation (PSV), neurally adjusted ventilatory assist (NAVA), and NAVA combined with external diaphragm pacing (NAVA + EDP). The primary outcome was diaphragmatic function, assessed using two ultrasonographic parameters: diaphragmatic excursion (DE) and diaphragm thickness fraction (DTF). Secondary outcomes included the following: (a) respiratory mechanics parameters, including electrical activity of the diaphragm (EAdi), plateau pressure (Pplat), static lung compliance (Cst), and airway resistance (Raw); (b) gas exchange indices, such as partial pressure of arterial carbon dioxide (PaCO) and PaO/FiO ratio; and (c) clinical outcomes, namely duration of mechanical ventilation (DMV) and intensive care unit length of stay (ILOS). Compared to the PSV group, the NAVA group exhibited significantly higher DE and DTF values at 72 h and 96 h (all P < 0.05). Furthermore, the NAVA + EDP group demonstrated increased DE levels at 48 h, 72 h, and 96 h, along with elevated DTF values at 72 h and 96 h (all P < 0.05). Additionally, the NAVA group showed significantly shorter durations of DMV and ILOS compared to the PSV group, while the NAVA + EDP group further reduced both DMV and ILOS durations relative to the NAVA group (all P < 0.05). NAVA + EDP treatment exhibited effectively in reducing DMV and improving clinical outcomes for mechanically ventilated patients with AECOPD.
膈肌功能障碍是机械通气患者中常见的并发症，与脱机时间延长和死亡率增加密切相关。神经调节通气辅助（NAVA）通过膈肌肌电图监测使呼吸机支持与神经呼吸驱动同步，已证明在维持膈肌收缩力方面具有疗效。与此互补的是，体外膈肌起搏（EDP）通过有针对性的膈神经刺激减轻通气引起的膈肌萎缩。然而，NAVA + EDP联合治疗在慢性阻塞性肺疾病急性加重期（AECOPD）中的协同潜力尚未得到探索。这项前瞻性随机试验纳入了60例机械通气的AECOPD患者，将他们平均分为三组（每组n = 20）：传统压力支持通气（PSV）、神经调节通气辅助（NAVA）和NAVA联合体外膈肌起搏（NAVA + EDP）。主要结局是膈肌功能，使用两个超声参数进行评估：膈肌移动度（DE）和膈肌厚度分数（DTF）。次要结局包括：（a）呼吸力学参数，包括膈肌电活动（EAdi）、平台压（Pplat）、静态肺顺应性（Cst）和气道阻力（Raw）；（b）气体交换指标，如动脉血二氧化碳分压（PaCO）和PaO/FiO比值；以及（c）临床结局，即机械通气时间（DMV）和重症监护病房住院时间（ILOS）。与PSV组相比，NAVA组在72小时和96小时时的DE和DTF值显著更高（所有P < 0.05）。此外，NAVA + EDP组在48小时、72小时和96小时时DE水平升高，在72小时和96小时时DTF值升高（所有P < 0.05）。此外，与PSV组相比，NAVA组的DMV和ILOS持续时间显著缩短，而NAVA + EDP组相对于NAVA组进一步缩短了DMV和ILOS持续时间（所有P < 0.05）。NAVA + EDP治疗在降低机械通气的AECOPD患者的DMV和改善临床结局方面表现有效。
