Dres, Martin ORCID: 0000-0001-9191-6089, de Abreu, Marcelo Gama, Merdji, Hamid, Muller-Redetzky, Holger, Dellweg, Dominic, Randerath, Winfried J., Mortaza, Satar, Jung, Boris, Bruells, Christian, Moerer, Onnen, Scharffenberg, Martin ORCID: 0000-0002-5385-9607, Jaber, Samir, Besset, Sebastien, Bitter, Thomas, Geise, Arnim, Heine, Alexander, Malfertheiner, Maximilian, V, Kortgen, Andreas, Benzaquen, Jonathan, Nelson, Teresa, Uhrig, Alexander, Moenig, Olaf, Meziani, Ferhat, Demoule, Alexandre and Similowski, Thomas (2022). Randomized Clinical Study of Temporary Transvenous Phrenic Nerve Stimulation in Difficult-to-Wean Patients. Am. J. Respir. Crit. Care Med., 205 (10). S. 1169 - 1179. NEW YORK: AMER THORACIC SOC. ISSN 1535-4970

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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: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Dres, MartinUNSPECIFIEDorcid.org/0000-0001-9191-6089UNSPECIFIED
de Abreu, Marcelo GamaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Merdji, HamidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muller-Redetzky, HolgerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dellweg, DominicUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Randerath, Winfried J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mortaza, SatarUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jung, BorisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bruells, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Moerer, OnnenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Scharffenberg, MartinUNSPECIFIEDorcid.org/0000-0002-5385-9607UNSPECIFIED
Jaber, SamirUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Besset, SebastienUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bitter, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Geise, ArnimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heine, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Malfertheiner, Maximilian, VUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kortgen, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Benzaquen, JonathanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nelson, TeresaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Uhrig, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Moenig, OlafUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meziani, FerhatUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Demoule, AlexandreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Similowski, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-697616
DOI: 10.1164/rccm.202107-1709OC
Journal or Publication Title: Am. J. Respir. Crit. Care Med.
Volume: 205
Number: 10
Page Range: S. 1169 - 1179
Date: 2022
Publisher: AMER THORACIC SOC
Place of Publication: NEW YORK
ISSN: 1535-4970
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
MECHANICAL VENTILATION; INTENSIVE-CARE; DIAPHRAGM; MUSCLE; DYSFUNCTION; WEAKNESS; IMPACT; TRIAL; ICUMultiple languages
Critical Care Medicine; Respiratory SystemMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/69761

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