Phrenic Nerve Stimulation

Weakness of the limbs and respiratory muscles has increasingly been found to be a frequent event that complicates the medical history of patients in Intensive Care. The problem normally affects more serious cases and presents as muscular weakness leading to flaccid paralysis and difficulty in weaning patients off mechanical ventilation. This latter sign leads the intensivist to suspect possible involvement of the neuromuscular respiratory system. Unfortunately, in-depth clinical assessment of the neuromuscular respiratory system is difficult with critically ill patients, and electrophysiological studies have been used instead to overcome this problem. Of these latter, electric and electromagnetic stimulation of the phrenic nerve have been successful (along with needle electromyography of the diaphragm) in identifying the causes of neuromuscular respiratory insufficiency, especially in Intensive Care. In this brief chapter, we will be discussing the technique of electric stimulation of the phrenic nerve and neuromuscular respiratory insufficiency within the field of critical illness polyneuropathy.