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Title:NEINVAZIVNA BILATERALNA ELEKTRIČNA STIMULACIJA FRENIČNEGA ŽIVCA ZA PREPREČEVANJE ATROFIJE DIAFRAGMALNIH MIŠIČNIH VLAKEN
Authors:ID Galjot, Tina (Author)
ID Mirković, Tomislav (Mentor) More about this mentor... New window
ID Rakef, Janko (Comentor)
Files:.pdf 4448$$Galjot_Tina_MD.pdf (1,75 MB)
MD5: DC944F07A02C8D88A8D159F56525A009
 
Language:Slovenian
Work type:Master's thesis/paper
Organization:UNM FZV - University of Novo mesto - Faculty of Health Sciences
Abstract:Izhodišča: Ventilatorsko inducirana disfunkcija diafragme (VIDD) je pogost zaplet pri kritično bolnih na mehanski ventilaciji. Razvije se že v prvih 18–24 urah, vodi v atrofijo diafragme, podaljšano ventilacijo in povečano smrtnost. Neinvazivna bilateralna transkutana električna stimulacija freničnega živca (TEDS) je obetavna strategija za preprečevanje VIDD, vendar sta njena izvedljivost in učinkovitost pri ljudeh še premalo raziskani. Metode: V prospektivni pilotni študiji smo pri 20 zdravih odraslih prostovoljcih (10 žensk, 10 moških; povprečna starost 30,7 ± 8,5 leta), priključenih na CPAP (PEEP 5 cmH2O, FiO2 21 %), izvedli bilateralno TEDS pri 5 mA in 10 mA. Uporabili smo znotrajraziskovalni dizajn s ponovljenimi meritvami v treh pogojih: brez stimulacije (T0), pri 5 mA (T1) in pri 10 mA (T2). Merili smo ultrazvočno ekskurzijo diafragme, frakcijo zadebelitve (TFdi), respiratorno pobudo (manever P0.1), subjektivno toleranco ter vitalne znake. Rezultati: Ekskurzija diafragme se je statistično značilno povečala z 2,74 ± 1,48 cm (T0) na 3,34 ± 1,80 cm pri 5 mA (p = 0,046) in 4,04 ± 2,10 cm pri 10 mA (p < 0,001) z jasno dozno-odzivno odvisnostjo (p = 0,006). TFdi se ni statistično značilno spremenila. Vrednosti manevra P0.1 so postale bolj negativne (p < 0,001). Povprečna ocena nelagodja je znašala 1,35/10 pri 5 mA in 3,60/10 pri 10 mA. Klinično pomembnih neželenih dogodkov nismo zaznali. Razprava: Neinvazivna bilateralna TEDS je izvedljiva, varna in fiziološko učinkovita metoda pri zdravih odraslih, ki povzroči dozno-odzivno povečanje ekskurzije diafragme. Rezultati predstavljajo dokaz koncepta in utemeljujejo nadaljnje klinične študije pri mehansko ventiliranih bolnikih.
Keywords:diafragma, ventilatorsko inducirana disfunkcija diafragme, frenični živec, transkutana električna stimulacija
Year of publishing:2026
PID:20.500.12556/ReVIS-14139 New window
Publication date in ReVIS:02.07.2026
Views:40
Downloads:2
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Secondary language

Language:English
Title:NON-INVASIVE BILATERAL ELECTRICAL STIMULATION OF THE PHRENIC NERVES TO PREVENT ATROPHY OF DIAPHRAGMATIC MUSCLE FIBRES
Abstract:Introduction: Ventilator-induced diaphragmatic dysfunction (VIDD) is a common complication in critically ill patients receiving mechanical ventilation. It develops within the first 18–24 hours and leads to diaphragmatic atrophy, prolonged ventilation, and increased mortality. Non invasive bilateral transcutaneous electrical stimulation of the phrenic nerve (TEDS) is a promising strategy to prevent VIDD, but its feasibility and effectiveness in humans remain insufficiently investigated. Methods: In this prospective pilot study, 20 healthy adult volunteers (10 females, 10 males; mean age 30.7 ± 8.5 years) connected to CPAP (PEEP 5 cmH2O, FiO2 21%) underwent bilateral TEDS at 5 mA and 10 mA. We used a within-subject repeated-measures design with three conditions: no stimulation (T0), 5 mA (T1), and 10 mA (T2). We measured diaphragmatic excursion by ultrasound, thickening fraction (TFdi), respiratory drive (P0.1 maneuver), subjective tolerance, and vital signs. Results: Diaphragmatic excursion increased significantly from 2.74 ± 1.48 cm (T0) to 3.34 ± 1.80 cm at 5 mA (p = 0.046) and 4.04 ± 2.10 cm at 10 mA (p < 0.001), with a clear dose–response relationship (p = 0.006). TFdi did not change significantly. P0.1 maneuver values became more negative (p < 0.001). Mean discomfort scores were 1.35/10 at 5 mA and 3.60/10 at 10 mA. No clinically relevant adverse events were observed. Discussion: Non-invasive bilateral TEDS is a feasible, safe, and physiologically effective method in healthy adults that induces a dose-dependent increase in diaphragmatic excursion. These results provide proof of concept and justify further clinical studies in mechanically ventilated patients.
Keywords:diaphragm, ventilator-induced diaphragmatic dysfunction, phrenic nerve, transcutaneous electrical stimulation


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