TY - JOUR T1 - Can phrenic stimulation protect the diaphragm from mechanical ventilation-induced damage? JF - European Respiratory Journal JO - Eur Respir J SP - 280 LP - 283 DO - 10.1183/09031936.00045613 VL - 42 IS - 1 AU - Hicham Masmoudi AU - Catherine Coirault AU - Alexandre Demoule AU - Julien Mayaux AU - Maud Beuvin AU - Norma Romero AU - Jalal Assouad AU - Thomas Similowski Y1 - 2013/07/01 UR - http://erj.ersjournals.com/content/42/1/280.abstract N2 - To the Editor:Mechanical ventilation is a prominent lifesaving treatment. It is, however, associated with an array of adverse effects, which include ventilator-associated pneumonias, volume-induced lung injury and, more recently identified, ventilator-induced diaphragm dysfunction (VIDD) [1–3]. VIDD combines diaphragm weakness with muscle fibre atrophy, remodelling and injury. Its mechanisms involve decreased protein synthesis, increased proteolysis, increased oxidative stress and mitochondrial dysfunction [2, 4]. Controlled mechanical ventilation appears to be the main, if not the sole, risk factor for VIDD, which in animal models is attenuated by the maintenance of respiratory efforts (assisted ventilatory modes) [2]. Although the corresponding human evidence is still lacking, this underlies the current notion that “clinicians should encourage persistent diaphragmatic activity” in patients receiving mechanical ventilation [2]. Diaphragm pacing has been proposed as a surrogate for spontaneous respiratory activity when the latter is not compatible with the condition of the patient [2, 5], but this approach has, seemingly, not yet been tested experimentally.Here we report a preliminary description of putative beneficial effects of diaphragm pacing in three mechanically ventilated sheep. Three female adult sheep (41, 32 and 34 kg), were anaesthetised (premedication: acepromazine 1.3 mg·kg−1 i.m., 30 min before induction; induction: propofol 6 mg·kg−1 i.v.; maintenance: continuous propofol 1–2 mg·kg−1·h−1, midazolam 0.3–2 mg·kg−1·h−1 and morphine 0.2–0.3 mg·kg−1·h−1; no paralysing agents), tracheotomised and mechanically ventilated with a minute ventilation ensuring normocapnia (Aisys, GE Healthcare, Datex Ohmeda, Madison, WI, USA). Additional oxygen was given to maintain transcutaneous-pulsed oxygen saturation >92%. Adequate fluid and nutritional support was provided and glycaemia controlled. Body temperature, heart rate and arterial pressure were monitored. Intradiaphragmatic phrenic nerve stimulation electrodes were inserted bilaterally in … ER -