INTRODUCTION Mechanical ventilation (MV) induced diaphragmatic atrophy can contribute to weaning difficulties. A temporary transvenous diaphragm neurostimulation (TTDN) device that elicits diaphragm contractions has previously been shown to mitigate atrophy… Click to show full abstract
INTRODUCTION Mechanical ventilation (MV) induced diaphragmatic atrophy can contribute to weaning difficulties. A temporary transvenous diaphragm neurostimulation (TTDN) device that elicits diaphragm contractions has previously been shown to mitigate atrophy during MV in a preclinical model; however, its effects on different myofiber types remain unknown. It is important to examine these effects, as each myofiber type plays a role in the range of diaphragmatic movements to ensure successful liberation from MV. METHODS Eighteen pigs were assigned to one of three ventilation conditions for 50 hours: MV-Only, and TTDN contracting the diaphragm every other breath or every breath synchronously with MV (TTDN50%+MV and TTDN100%+MV, respectively). Six pigs were assigned to a never-ventilated, never-paced (NV-NP) group. Diaphragm biopsies were fiber-typed and myofiber cross-sectional areas were measured and normalized to subject weight. RESULTS There were effect differences based on TTDN exposure. The TTDN100%+MV group showed less atrophy in Type 2A and 2X myofibers than the TTDN50%+MV group, relative to the NV-NP group. The TTDN50%+MV animals showed less MV-induced atrophy in Type 1 myofibers than TTDN100%+MV animals. Additionally, there were no significant differences in proportions of myofiber types between each condition. CONCLUSION TTDN applied synchronously with MV for 50 hours mitigates MV-induced atrophy in all myofiber types, with no evidence of stimulation-induced myofiber-type shift. At this stimulation profile, enhanced protection for Type 1 myofibers and Type 2 myofibers was seen when diaphragm contractions occurred every other breath and every breath, respectively.
               
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