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Anterior magnetic phrenic nerve stimulation: laboratory and clinical evaluation

Abstract

Objective: Anterior magnetic stimulation (aMS) of the phrenic nerves is a new method for the assessment of diaphragm contractility that might have particular applications for the clinical assessment of critically ill patients who are commonly supine. Design: We compared aMS with existing techniques for measurement of diaphragm weakness and fatigue in 10 normal subjects, 27 ambulant patients with suspected diaphragm weakness and 10 critically ill patients. Setting: Laboratory and intensive care unit of two university hospitals. Results: Although aMS was not demonstrably supramaximal in normal subjects, the mean value of twitch transdiaphragmatic pressure (Tw Pdi) obtained at 100 % of stimulator output, 23.7 cmH2O, did not differ significantly from that obtained with bilateral supramaximal electrical stimulation (ES), 24.9 cmH2O, or bilateral anterior magnetic phrenic nerve stimulation (BAMPS), 27.3 cmH2O. A fatiguing protocol produced a 20 % fall in aMS-Tw Pdi and a 19 % fall in BAMPS-Tw Pdi; the fall in aMS-Tw Pdi correlated with the fall in BAMPS-Tw Pdi (r 2 = 0.84, p = 0.03) indicating that aMS can detect diaphragm fatigue. In ambulant patients aMS agreed closely with existing measures of diaphragm strength. The maximal sniff Pdi correlated with both the aMS-Tw Pdi (r 2 = 0.60, p < 0.0001) and the BAMPS-Tw Pdi (r 2 = 0.65, p < 0.0001) and the aMS-Tw Pdi was a mean (SD) 2.2 (4.3) cmH2O less than BAMPS-Tw Pdi. In addition, aMS correctly identified diaphragm dysfunction in patients studied on the ICU. Conclusions: We conclude that aMS is of clinical value for the investigation of suspected diaphragm weakness.

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Received: 11 November 1999 Final revision received: 17 April 2000 Accepted: 26 April 2000

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Polkey, M., Duguet, A., Luo, Y. et al. Anterior magnetic phrenic nerve stimulation: laboratory and clinical evaluation. Intensive Care Med 26, 1065–1075 (2000). https://doi.org/10.1007/s001340051319

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  • Key words Magnetic stimulation
  • Phrenic nerves
  • Diaphragm
  • Fatigue