Acute and Critical Care

Review Article

Anesthesiology
Rehabilitating the diaphragm: an integrated approach to intensive care unit-acquired dysfunction in critical illness—a narrative review: Ricardo Arriagada, Aaron Pagan, Daniela Nisticò, Francesca Gualdi, Valentina Fassone, Nicolò Antonino Patroniti, Patricia RM Rocco, Denise Battaglini; Acute Crit Care. 2026;41(2):237-251. Published online March 4, 2026; DOI: https://doi.org/10.4266/acc.004375

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Abstract PDF: Improved survival in critical illness has increased recognition of intensive care unit (ICU) complications, particularly ICU-acquired weakness, which affects up to 25% of patients. Diaphragm involvement is common and contributes to prolonged ventilation, difficult weaning, and worse outcomes. Dysfunction arises from ventilator-induced injury, sepsis-related myopathy, or both. Although early mobilization and physiotherapy improve recovery, their effectiveness is often limited by respiratory muscle fatigue and dyspnea. Non-invasive ventilation (NIV) reduces the work of breathing, sustains spontaneous effort, and enhances exercise tolerance, thereby facilitating earlier and safer rehabilitation. This review summarizes the current understanding of the pathophysiology of ICU-acquired diaphragm dysfunction. It explores the role of NIV and other respiratory supports as an adjunct to physiotherapy aimed at optimizing recovery in critically ill patients.

Original Articles

Cardiology
Diaphragm ultrasound for predicting weaning success in post-cardiac surgery acute respiratory distress syndrome patients: a prospective observational study in China: Yuan-Qin Huang, Pei Yu, Dou-Dou Xiang, Quan Gan; Acute Crit Care. 2025;40(3):435-443. Published online August 21, 2025; DOI: https://doi.org/10.4266/acc.004320

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Abstract PDF: Background
To explore the value of the diaphragm thickness fraction (TF) and diaphragm mobility (DM) measured by ultrasound for predicting ventilator withdrawal success in patients with acute respiratory distress syndrome (ARDS) after cardiac surgery. Methods: This study included 246 patients undergoing the spontaneous breathing trial. Diaphragmatic function was evaluated by ultrasound, including the diaphragm thickness at the end of calm breathing (thickness of the diaphragm at functional residual capacity [TdiFRC]) and the maximum diaphragm thickness at the end of inspiration (thickness of the diaphragm at full vital capacity [TdiFVC]); TF=(TdiFVC–TdiFRC)/TdiFRC×100%. DM, the oxygenation index (the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen), and the rapid shallow breathing index (RSBI) were measured. Results: Successful liberation from mechanical ventilation was observed in 209 patients. There were no significant differences in the TdiFRC (0.3±0.1 cm vs. 0.3±0.1 cm) or TdiFVC (0.3±0.1 cm vs. 0.2±0.1 cm) between the ventilator withdrawal success group and the ventilator withdrawal failure group (P>0.05). The TF was greater in the ventilator withdrawal success group than in the ventilator withdrawal failure group (40.8%±15.8% vs. 37.7%±9.2%, P<0.01). DM in the ventilator withdrawal success group was greater than that in the ventilator withdrawal failure group (1.5±0.5 cm vs. 1.2±0.4 cm, P=0.040). The RSBI was lower in the ventilator withdrawal success group than in the ventilator withdrawal failure group (74.3±25.6 breaths·min–1·L –1 vs. 89.9±34.5 breaths·min–1·L –1, P<0.01). Conclusions: Diaphragmatic ultrasound can be used to predict the success of ventilator withdrawal in patients with ARDS.

Pulmonary
Evaluating diaphragmatic dysfunction and predicting non-invasive ventilation failure in acute exacerbation of chronic obstructive pulmonary disease in India: Nupur B Patel, Gaurav Jain, Udit Chauhan, Ajeet Singh Bhadoria, Saurabh Chandrakar, Haritha Indulekha; Acute Crit Care. 2023;38(2):200-208. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01060

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Abstract PDF

Background
Baseline diaphragmatic dysfunction (DD) at the initiation of non-invasive ventilation (NIV) correlates positively with subsequent intubation. We investigated the utility of DD detected 2 hours after NIV initiation in estimating NIV failure in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients.
Methods
In a prospective-cohort design, we enrolled 60 consecutive patients with AECOPD initiated on NIV at intensive care unit admission, and NIV failure events were noted. The DD was assessed at baseline (T1 timepoint) and 2 hours after initiating NIV (T2 timepoint). We defined DD as ultrasound-assessed change in diaphragmatic thickness (ΔTDI) <20% (predefined criteria [PC]) or its cut-off that predicts NIV failure (calculated criteria [CC]) at both timepoints. A predictive-regression analysis was reported.
Results
In total, 32 patients developed NIV failure, nine within 2 hours of NIV and remaining in next 6 days. The ∆TDI cut-off that predicted NIV failure (DD-CC) at T1 was ≤19.04% (area under the curve [AUC], 0.73; sensitivity, 50%; specificity, 85.71%; accuracy; 66.67%), while that at T2 was ≤35.3% (AUC, 0.75; sensitivity, 95.65%; specificity, 57.14%; accuracy, 74.51%; hazard ratio, 19.55). The NIV failure rate was 35.1% in those with normal diaphragmatic function by PC (T2) versus 5.9% by CC (T2). The odds ratio for NIV failure with DD criteria ≤35.3 and <20 at T2 was 29.33 and 4.61, while that for ≤19.04 and <20 at T1 was 6, respectively.
Conclusions
The DD criterion of ≤35.3 (T2) had a better diagnostic profile compared to baseline and PC in prediction of NIV failure.

Citations

Citations to this article as recorded by

Research Progress on Factors Influencing the Failure of Non-Invasive Respiratory Support Treatment
嘉祺李
Advances in Clinical Medicine.2026; 16(01): 2301. CrossRef
Explainable deep-learning models to predict diaphragmatic dysfunction and cognitive stress in ICU patients under mechanical ventilation
Yonghua Wang, Yuling Bai, Ge Jin
Frontiers in Physiology.2026;[Epub] CrossRef
Association between diaphragm thickening fraction and noninvasive ventilation failure in patients with acute respiratory failure in the emergency department
Mohammed Imaad Khateeb, Mohammad Khalid, Sachin Nayak Sujir, Siddhi Naik, Prabha Prakash, Vimal Krishnan S.
European Journal of Emergency Medicine.2026;[Epub] CrossRef
Diaphragm ultrasound as a predictor for the need for respiratory support at discharge in patients with exacerbation of chronic obstructive pulmonary disease
Chitra Veluthat, Kavitha Venkatnarayan, Sumithra Selvam, Uma Devaraj, Priya Ramachandran, Uma Maheswari Krishnaswamy
Monaldi Archives for Chest Disease.2025;[Epub] CrossRef
The Application of Diaphragm Ultrasound in Chronic Obstructive Pulmonary Disease: A Narrative Review
Heng Mu, Qunxia Zhang
COPD: Journal of Chronic Obstructive Pulmonary Disease.2024;[Epub] CrossRef
Risk prediction models for non-invasive ventilation failure in patients with chronic obstructive pulmonary disease: A systematic review
Yuming Gao, Bo Yuan, Peng Fan, Mingtao Li, Jiarui Chen
Medicine.2024; 103(51): e40588. CrossRef
Advancing healthcare through thoracic ultrasound research in older patients
Simone Scarlata, Chukwuma Okoye, Sonia Zotti, Fulvio Lauretani, Antonio Nouvenne, Nicoletta Cerundolo, Adriana Antonella Bruni, Monica Torrini, Alberto Finazzi, Tessa Mazzarone, Marco Lunian, Irene Zucchini, Lorenzo Maccioni, Daniela Guarino, Silvia Fabbr
Aging Clinical and Experimental Research.2023; 35(12): 2887. CrossRef

Pulmonary
The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience: Lokesh Kumar Lalwani, Manjunath B Govindagoudar, Pawan Kumar Singh, Mukesh Sharma, Dhruva Chaudhry; Acute Crit Care. 2022;37(3):347-354. Published online July 25, 2022; DOI: https://doi.org/10.4266/acc.2022.00108

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Abstract PDF Supplementary Material

Background
Acute respiratory failure (ARF) is commonly managed with invasive mechanical ventilation (IMV). The majority of the time that a patient spends on IMV is in the process of weaning. Prediction of the weaning outcome is of paramount importance, as untimely/delayed extubation is associated with a high risk of mortality. Diaphragmatic ultrasonography is a promising tool in the intensive care unit, and its utility in predicting the success of weaning remains understudied.
Methods
In this prospective-observational study, we recruited 54 ARF patients on IMV, along with 50 healthy controls. During a spontaneous breathing trial, all subjects underwent diaphragmatic ultrasonography along with a rapid shallow breathing index (RSBI) assessment.
Results
The mean age was 41.8±17.0 and 37.6±10.5 years among the cases and control group, respectively. Demographic variables were broadly similar in the two groups. The most common cause of ARF was obstructive airway disease. The average duration of IMV was 5.41±2.81 days. Out of 54 subjects, 45 were successfully weaned, while nine patients failed weaning. Age, body mass index, and severity of disease were similar in the successful and failed weaning patients. The sensitivity in predicting successful weaning of percent change in diaphragmatic thickness (Δtdi%) >29.71% was high (93.33%), while specificity was 66.67%. The sensitivity and specificity of mean diaphragmatic thickness (tdi) end-expiratory >0.178 cm was 60.00% and 77.78%, respectively. RSBI at 1 minute of <93.75 had an equally high sensitivity (93.33%) but a lower specificity (22.22%). Similar results were also found for RSBI measured at 5 minutes.
Conclusions
During the weaning assessment, the purpose is to minimize both premature as well as delayed extubation. We found that diaphragmatic ultrasonography, in particular Δtdi%, is better than RSBI in predicting weaning outcomes.

Citations

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Predictive accuracy of lung and diaphragmatic ultrasound in weaning from mechanical ventilation: a comparison with the Rapid Shallow Breathing Index
Shalini Bellan, Komaldeep Kaur, Surabhi Jaggi, Mandeep Kaur Sodhi, Deepak Aggarwal, Varinder Saini, Narinder Kaur, Manpreet Singh
Monaldi Archives for Chest Disease.2026;[Epub] CrossRef
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Hsin-Lun Yang, Ching-Hsia Hung, Yu-Ting Huang, Hui-Ching Cheng, Yau-Lin Tseng, Jun-Ming Su, Kun-Ling Tsai
Therapeutic Advances in Respiratory Disease.2026;[Epub] CrossRef
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Sanjivani Kamble, Yukta Churi, Rajesh Kuber
Journal of Clinical Sciences.2026; 23(2): 77. CrossRef
Évaluation de la dysfonction du diaphragme
M. Daniel, C. Delplancke, P. Desforges, K. Guessous, J. Castillo, T. Groseil, B. Cholley
EMC - Pneumologie.2026; 37(3): 1. CrossRef
Point-of-Care Ultrasound, an Integral Role in the Future of Enhanced Recovery After Surgery?
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Gulus Emre, Daniel Acosta, Cameron Baston
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Journal of Ultrasound in Medicine.2024; 43(2): 223. CrossRef
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Diego Poddighe, Marine Van Hollebeke, Yasir Qaiser Choudhary, Débora Ribeiro Campos, Michele R. Schaeffer, Jan Y. Verbakel, Greet Hermans, Rik Gosselink, Daniel Langer
Critical Care.2024;[Epub] CrossRef
Ultrasonographic evaluation of diaphragm thickness and excursion: correlation with weaning success in trauma patients: prospective cohort study
Golnar Sabetian, Mandana Mackie, Naeimehossadat Asmarian, Mahsa Banifatemi, Gregory A. Schmidt, Mansoor Masjedi, Shahram Paydar, Farid Zand
Journal of Anesthesia.2024; 38(3): 354. CrossRef
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Yashar Iran Pour, Afrooz Zandifar
European Journal of Translational Myology.2024;[Epub] CrossRef
Diaphragm dysfunction as a prognostic criterion of external respiratory impairment and necessary extracorporeal membrane oxygenation in patients with chronic heart failure
V.S. Shabaev, V.A. Mazurok, L.Z. Biktasheva, L.G. Vasilyeva, K.Yu. Kozhieva, I.A. Danilova, N.A. Osipova
Russian Journal of Anesthesiology and Reanimatology.2024; (6): 38. CrossRef
Diaphragmatic ultrasound: A new frontier in weaning from mechanical ventilation
Manoj Kamal, Saikat Sengupta
Indian Journal of Anaesthesia.2023; 67(Suppl 4): S205. CrossRef

Pulmonary
Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index: Mohammad Jhahidul Alam, Simanta Roy, Mohammad Azmain Iktidar, Fahmida Khatun Padma, Khairul Islam Nipun, Sreshtha Chowdhury, Ranjan Kumar Nath, Harun-Or Rashid; Acute Crit Care. 2022;37(1):94-100. Published online January 11, 2022; DOI: https://doi.org/10.4266/acc.2021.01354

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Abstract PDF

Background
In 3%–19% of patients, reintubation is needed 48–72 hours following extubation, which increases intensive care unit (ICU) morbidity, mortality, and expenses. Extubation failure is frequently caused by diaphragm dysfunction. Ultrasonography can be used to determine the mobility and thickness of the diaphragm. This study looked at the role of diaphragm excursion (DE) and thickening fraction in predicting successful extubation from mechanical ventilation.
Methods
Thirty-one patients were extubated with the advice of an ICU consultant using the ICU weaning regimen and diaphragm ultrasonography was performed. Ultrasound DE and thickening fraction were measured three times: at the commencement of the t-piece experiment, at 10 minutes, and immediately before extubation. All patients' parameters were monitored for 48 hours after extubation. Rapid shallow breathing index (RSBI) was also measured at the same time.
Results
Successful extubation was significantly correlated with DE (P=0.01). Receiver curve analysis for DE to predict successful extubation revealed good properties (area under the curve [AUC], 0.83; P<0.001); sensitivity, 77.8%; specificity, 84.6%, positive predictive value (PPV), 87.5%; negative predictive value (NPV), 73.3% while cut-off value, 11.43 mm. Diaphragm thickening fraction (DTF) also revealed moderate curve properties (AUC, 0.69; P=0.06); sensitivity, 61.1%; specificity, 84.6%; PPV, 87.5%; NPV, 61.1% with cut-off value 22.33% although former one was slightly better. RSBI could not reach good receiver operating characteristic value at cut-off points 100 b/min/L (AUC, 0.58; P=0.47); sensitivity, 66.7%; specificity, 53.8%; PPV, 66.7%; NPV, 53.8%).
Conclusions
To decrease the rate of reintubation, DE and DTF are better indicators of successful extubation. DE outperforms DTF.

Citations

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Nurse-performed diaphragm ultrasound integrated with spontaneous breathing trial criteria for risk stratification of extubation outcomes in neurosurgical critically ill patients: a multicenter prospective cohort study
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Frontiers in Medicine.2026;[Epub] CrossRef
Diaphragmatic and lung ultrasound as predictors of weaning outcomes of mechanically ventilated patients
Elsayed A. Elkotory, Amira A. Elkholy, Mohamed A. Eltomy, Gehan H. Abo El-magd, Ibrahim S. Ibrahim
Tanta Medical Journal.2026; 54(2): 286. CrossRef
Diaphragmatic ultrasound in mechanically ventilated critically ill patients: a narrative review
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Evaluation of Diaphragmatic Dysfunction in Mechanically Ventilated Critically Ill Subjects
Josehélen Dornelles Martini, Francisco Xavier de Araujo, Cassiano Teixeira
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Predicting weaning failure from invasive mechanical ventilation: The promise and pitfalls of clinical prediction scores
Maneesh Gaddam, Dedeepya Gullapalli, Zayaan A Adrish, Arnav Y Reddy, Muhammad Adrish
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Critical illness-associated limb and diaphragmatic weakness
Valentine Le Stang, Nicola Latronico, Martin Dres, Michele Bertoni
Current Opinion in Critical Care.2024; 30(2): 121. CrossRef
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Henry M. Parada-Gereda, Adriana L. Tibaduiza, Alejandro Rico-Mendoza, Daniel Molano-Franco, Victor H. Nieto, Wanderley A. Arias-Ortiz, Purificación Perez-Terán, Joan R. Masclans
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T. G. Toledo, M. R. Bacci, Fred A. Luchette
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Ravi Saravanan, Krishnamurthy Nivedita, Krishnamoorthy Karthik, Rajagopalan Venkatraman
Indian Journal of Anaesthesia.2022; 66(8): 591. CrossRef
The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience
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Domenica Di Costanzo, Mariano Mazza, Antonio Esquinas
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Indian Journal of Anaesthesia.2022; 66(11): 776. CrossRef
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Case Reports

Cardiology/Pediatric
Extracorporeal Membrane Oxygenation Cannula Malposition in the Azygos Vein in a Neonate with Right-Sided Congenital Diaphragmatic Hernia: Seung Jun Choi, Chun-Soo Park, Won Kyoung Jhang, Seong Jong Park; Korean J Crit Care Med. 2016;31(2):152-155. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.152

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Abstract PDF

Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.

Citations

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Inadvertent cannulation of the azygos vein during eCPR
Shelina M. Jamal, Deborah S. Fruitman, Kevin M. Lichtenstein, Darren H. Freed, Natalie L. Yanchar
Journal of Pediatric Surgery Case Reports.2021; 71: 101941. CrossRef
Identification of Inadvertent Azygous Vein Cannulation Using Transthoracic Echocardiography During Venoarterial Extracorporeal Membrane Oxygenation Initiation
Bethany G. Runkel, Jason D. Fraser, John M. Daniel, Karina M. Carlson
CASE.2019; 3(2): 67. CrossRef
Successful Extracorporeal Membrane Oxygenation After Incidental Azygos Vein Cannulation in a Neonate With Right-Sided Congenital Diaphragmatic Hernia Interruption of the Inferior Vena Cava and Azygos Continuation
Alessandra Mayer, Genny Raffaeli, Federico Schena, Valeria Parente, Gabriele Sorrentino, Francesco Macchini, Anna Maria Colli, Lucia Mauri, Simona Neri, Irene Borzani, Ernesto Leva, Fabio Mosca, Giacomo Cavallaro
Frontiers in Pediatrics.2019;[Epub] CrossRef
The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)
Ji Young Lee
Korean Journal of Critical Care Medicine.2016; 31(2): 73. CrossRef

A Chronic Traumatic Diaphragmatic Hernia Presenting 36 Years after Preceding Injury: A Case Report: Kyung Hwa Kim, Ja Hong Kuh, Tae Yoon Kim; Korean J Crit Care Med. 2010;25(3):199-202.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.199

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Abstract PDF: We report a distinctive case of a large traumatic diaphragmatic hernia (TDH) that presented 36-years after the preceding injury. We believe this case represents the most delayed (TDH) presentation ever reported in Korea. This paper describes the particular presentation, including the operative and postoperative management of this patient. We also review the management of long delayed TDH presentation and the postoperative issues concerning thoracic cavity dead space and propensity of the repaired diaphragm for developing abdominal compartment syndrome.

Original Articles

Successful Weaning after Diaphragmatic Plication in an Infant with Phrenic Nerve Palsy Resulting from Removal of Cavernous Lymphangioma: Jang Ho Roh, Dong Woo Han, Shin Ok Koh, Yong Taek Nam; Korean J Crit Care Med. 2001;16(2):156-159.

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Abstract PDF: Phrenic nerve palsy is a well-known complication following cardiac surgery in children. The incidence is approximately 1~2%. In infants and young children, it often causes a life-threatening respiratory distress. They must be treated with mechanical ventilation in the ICU. Many patients with phrenic nerve injury who is impossible to wean from a ventilator are candidates of diaphragmatic plication. Diaphragmatic plication is performed to restore the normal pulmonary parenchymal volume by replacing the diaphragm to its proper location. This is a case of 2-months-old infant who had phrenic nerve palsy after the removal of cavernous lymphangioma of the chest. He underwent 4 operations to remove the mass and to have pericardiotomy. We tried to wean him from the ventilator but failed several times in the ICU. After 4th operation, right diaphragmatic elevation was noted from the chest X ray. Phrenic nerve palsy was confirmed with fluoroscopy and he underwent diaphragmatic plication on 42 days after his 4th operation. Three days after the diaphragmatic plication, weaning was successfully carried out.

Development and Experimental Evaluation of Respiratory Assist Device by Use of Right Thoracic Negative Pressure Ventilation: Joong Hwan Oh, Sang Hun Lee, Hyun Kyo Lim, Young Hee Lee, Sung Hoon Kim; Korean J Crit Care Med. 2005;20(2):165-169.

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Abstract PDF: BACKGROUND
A diaphragm pacing with electrical stimulation is a new respiratory assist device which has advantages over mechanical ventilation. Unilateral phrenic nerve stimulation makes uneven distribution of intrathoracic negative pressure and most likely relates to paradoxical motion of the diaphragm. Our purpose is to investigate a respiratory effect of right phrenic nerve pacing after thoracotomy compared with bilateral pacing. METHODS: Five dogs were examined under the general anesthesia. Right 5th intercostal space was opened. Two pacing leads were placed around the phrenic nerve and connected to the stimulator. Chest wall was closed after chest tube insertion. Ventilator was off without self respiration. Swan-Ganz catheter was introduced to the pulmonary artery, cardiac output, central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP). Arterial blood gases (PO2 & PCO2), end-tidal PCO2 (PETCO2) and tidal volume were measured with nerve stimulation. Left phrenic nerve was managed as the same manner. RESULTS: Right phrenic nerve pacing resulted in a tidal volume of 186+/-5 ml, PETCO2 of 55.0+/-2.3 mmHg, Arterial PO2 of 115+/-12 mmHg, PCO2 of 59+/-4 mmHg, Cardiac output of 2.3+/-0.5 L/min, CVP of 12.0+/-2.3 mmHg, PCWP of 14.2+/-2.5 mmHg. Bilateral phrenic nerve pacing resulted in a tidal volume of 418+/-3 ml, PETCO2 of 47.0+/-2.7 mmHg, PO2 of 289+/-10 mmHg, PCO2 of 42+/-3 mmHg, Cardiac output of 3.1+/-0.4 L/min, CVP of 10.2+/-2.5 mmHg, PCWP of 14.5+/-2.7 mmHg. Right phrenic nerve pacing showed significantly lower tidal volume, PO2 and higher PETCO2 and arterial blood PCO2 (p<0.05).
CONCLUSIONS
Right phrenic nerve pacing plays a role to develop respiratory assist. However the effect is less than the bilateral pacing.

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