About one in three critically ill patients requires mechanical ventilation (MV). Prolonged MV, however, results in diaphragmatic weakness, which itself is associated with delayed weaning and increased mortality. Inducing active diaphragmatic contraction via electrical phrenic nerve stimulation (PNS) not only provides the potential to reduce diaphragmatic muscular atrophy but also generates physiological-like ventilation and therefore offers a promising alternative to MV. Reasons why PNS is not yet used in critical care medicine are high procedural invasiveness, insufficient evidence, and lack of side-by-side comparison to MV. This study aims to establish a minimal-invasive percutaneous, bilateral electrode placement approach for sole PNS breathing and thereby enable, for the first time, a breath-by-breath comparison to MV. Six juvenile German Landrace pigs received general anesthesia and orotracheal intubation. Following the novel ultrasound-guided, landmark-based, 4-step approach, two echogenic needles per phrenic nerve were successfully placed. Stimulation effectiveness was evaluated measuring tidal volume, diaphragmatic thickening and tomographic electrical impedance in a breath-by-breath comparison to MV. Following sufficient bilateral phrenic nerve stimulation in all pigs, PNS breaths showed a 2.2-fold increase in diaphragmatic thickening. It induced tidal volumes in the lung-protective range by negative pressure inspiration and improved dorso-caudal regional ventilation in contrast to MV. Our study demonstrated the feasibility of a novel ultrasound-guided, percutaneous phrenic nerve stimulation approach, which generated sufficient tidal volumes and showed more resemblance to physiological breathing than MV in a breath-by-breath comparison.

大约三分之一的危重患者需要机械通气 (MV)。然而，延长的 MV 会导致膈肌无力，这本身与断奶延迟和死亡率增加有关。通过膈神经电刺激 (PNS) 诱导主动膈肌收缩不仅具有减少膈肌萎缩的潜力，而且还能产生类似生理的通气，因此提供了一种有前途的 MV 替代方案。 PNS 尚未用于重症监护医学的原因是程序侵入性高、证据不足以及缺乏与 MV 的并列比较。本研究旨在建立一种用于单 PNS 呼吸的微创经皮双侧电极放置方法，从而首次能够与 MV 进行逐次呼吸比较。六头幼年德国长白猪接受全身麻醉和经口气管插管。遵循新颖的超声引导、基于标志的四步方法，成功地在每根膈神经上放置了两根回声针。通过与 MV 进行逐次呼吸比较，测量潮气量、膈肌增厚和断层扫描电阻抗来评估刺激效果。对所有猪进行充分的双侧膈神经刺激后，PNS 呼吸显示膈肌增厚增加了 2.2 倍。与 MV 相比，它通过负压吸气诱导肺保护范围内的潮气量，并改善背尾区域通气。我们的研究证明了一种新型超声引导、经皮膈神经刺激方法的可行性，该方法可产生足够的潮气量，并且在逐次呼吸比较中显示出比 MV 更类似于生理呼吸。