Am. J. Respir. Crit. Care Med., Volume 159, Number 6, June 1999, 2018-2020

Prevention of Human Diaphragm Atrophy with Short Periods of Electrical Stimulation

NAJIB T. AYAS, F. DENNIS MCCOOL, ROBERT GORE, STEVEN L. LIEBERMAN, and ROBERT BROWN

Pulmonary and Critical Care Medicine Section, Radiology Service, and Spinal Cord Injury Service; Brockton/West Roxbury VA Medical Center, West Roxbury; Harvard Medical School, Boston, Massachusetts; Department of Medicine, Memorial Hospital, Pawtucket; and Brown University Medical School, Providence, Rhode Island

We determined whether prolonged complete inactivation of the human diaphragm results in atrophy and whether this could be prevented by brief periods of electrical phrenic nerve stimulation. We studied a subject with high spinal cord injury who required removal of his left phrenic nerve pacemaker (PNP) and the reinstitution of positive-pressure ventilation for 8 mo. During this time, the right phrenic nerve was stimulated 30 min per day. Thickness of each diaphragm (tdi) was determined by ultrasonography. Maximal tidal volume (VT) was measured during stimulation of each diaphragm separately. After left PNP reimplantation, VT and tdi were measured just before the resumption of electrical stimulation and serially for 33 wk. On the previously nonfunctioning side, there were substantial changes in VT (from 220 to 600 ml) and tdi (from 0.18 to 0.34 cm). On the side that had been stimulated, neither VT nor tdi changed appreciably (VT from 770 to 900 ml; tdi from 0.25 to 0.28 cm). We conclude that prolonged inactivation of the diaphragm causes atrophy which may be prevented by brief periods of daily phrenic nerve stimulation.

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