The journal of trauma and acute care surgery · 2026
Diaphragm stimulation after human spinal cord injury: Effects on respiratory function and diaphragm muscle activation.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Vose Alicia K, Cavka Kathryn, Freeborn Paul, Tonuzi Geneva, Kerwin Andrew J, Yorkgitis Brian K, Fuller David, D'Alessandro Alison, Wauneka Clayton N, Croft Chasen, Fox Emily J
Аннотация
BACKGROUND: Respiratory dysfunction is a leading cause of morbidity and mortality after cervical spinal cord injury (C-SCI). Respiratory impairment is exacerbated by mechanical ventilation, which is associated with higher infection rates and diaphragm atrophy. Intramuscular stimulation of the diaphragm, that is, diaphragm pacing (DP), is a potential strategy to facilitate ventilator weaning, enhance respiratory function, and reduce complications. However, its impact on respiratory recovery and neuromuscular activation remains understudied.
METHODS: This prospective observational case series evaluated changes in respiratory function and diaphragm activation over two months in 11 patients with acute traumatic C-SCI who underwent DP. Outcomes included tidal volume, respiratory rate, minute ventilation, maximal inspiratory/expiratory pressure generation (MIP/MEP), forced vital capacity (FVC), and diaphragm electromyography (EMG) recorded from the implanted electrodes.
RESULTS: Participants demonstrated severe respiratory impairment at baseline, with tidal volumes averaging 2.8±1.3 mL/kg and FVC at 19±14% of predicted. Despite this, 89% weaned from mechanical ventilation within 41±19.8 days post-injury. Significant weekly improvements were evident in tidal volume (+0.26 mL/kg), respiratory rate (-0.66 breaths/min), and minute ventilation (+0.35 L/min). MIP and MEP increased by 3% predicted function per week, and FVC increased by 2% of predicted function per week. Diaphragm EMG amplitudes during quiet breathing decreased over time, particularly in patients with high baseline activation (>80% of maximum) possibly reflecting improved neuromuscular efficiency.
CONCLUSIONS: These findings suggest that DP may support early respiratory recovery after C-SCI improving respiratory function and diaphragm activation. Future research is needed to elucidate the underlying mechanisms and optimize clinical use of DP for respiratory recovery after C-SCI. ( J Trauma Acute Care Surg . 2026;101: 699-708.).
LEVEL OF EVIDENCE: Therapeutic Study; Level IV.
METHODS: This prospective observational case series evaluated changes in respiratory function and diaphragm activation over two months in 11 patients with acute traumatic C-SCI who underwent DP. Outcomes included tidal volume, respiratory rate, minute ventilation, maximal inspiratory/expiratory pressure generation (MIP/MEP), forced vital capacity (FVC), and diaphragm electromyography (EMG) recorded from the implanted electrodes.
RESULTS: Participants demonstrated severe respiratory impairment at baseline, with tidal volumes averaging 2.8±1.3 mL/kg and FVC at 19±14% of predicted. Despite this, 89% weaned from mechanical ventilation within 41±19.8 days post-injury. Significant weekly improvements were evident in tidal volume (+0.26 mL/kg), respiratory rate (-0.66 breaths/min), and minute ventilation (+0.35 L/min). MIP and MEP increased by 3% predicted function per week, and FVC increased by 2% of predicted function per week. Diaphragm EMG amplitudes during quiet breathing decreased over time, particularly in patients with high baseline activation (>80% of maximum) possibly reflecting improved neuromuscular efficiency.
CONCLUSIONS: These findings suggest that DP may support early respiratory recovery after C-SCI improving respiratory function and diaphragm activation. Future research is needed to elucidate the underlying mechanisms and optimize clinical use of DP for respiratory recovery after C-SCI. ( J Trauma Acute Care Surg . 2026;101: 699-708.).
LEVEL OF EVIDENCE: Therapeutic Study; Level IV.