Feasibility of transesophageal phrenic nerve stimulation.

Kaufmann, Elisa M; Krause, Sven; Geisshuesler, Lukas; Scheidegger, Olivier; Häberlin, Andreas; Niederhauser, Thomas (2023). Feasibility of transesophageal phrenic nerve stimulation. Biomedical engineering online, 22(1), p. 5. BioMed Central 10.1186/s12938-023-01071-5

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Every year, more than 2.5 million critically ill patients in the ICU are dependent on mechanical ventilation. The positive pressure in the lungs generated by the ventilator keeps the diaphragm passive, which can lead to a loss of myofibers within a short time. To prevent ventilator-induced diaphragmatic dysfunction (VIDD), phrenic nerve stimulation may be used.


The goal of this study is to show the feasibility of transesophageal phrenic nerve stimulation (TEPNS). We hypothesize that selective phrenic nerve stimulation can efficiently activate the diaphragm with reduced co-stimulations.


An in vitro study in saline solution combined with anatomical findings was performed to investigate relevant stimulation parameters such as inter-electrode spacing, range to target site, or omnidirectional vs. sectioned electrodes. Subsequently, dedicated esophageal electrodes were inserted into a pig and single stimulation pulses were delivered simultaneously with mechanical ventilation. Various stimulation sites and response parameters such as transdiaphragmatic pressure or airway flow were analyzed to establish an appropriate stimulation setting.


Phrenic nerve stimulation with esophageal electrodes has been demonstrated. With a current amplitude of 40 mA, similar response figures of the diaphragm activation as compared to conventional stimulation with needle electrodes at 10mA were observed. Directed electrodes best aligned with the phrenic nerve resulted in up to 16.9 % higher amplitude at the target site in vitro and up to 6 cmH20 higher transdiaphragmatic pressure in vivo as compared to omnidirectional electrodes. The activation efficiency was more sensitive to the stimulation level inside the esophagus than to the inter-electrode spacing. Most effective and selective stimulation was achieved at the level of rib 1 using sectioned electrodes 40 mm apart.


Directed transesophageal phrenic nerve stimulation with single stimuli enabled diaphragm activation. In the future, this method might keep the diaphragm active during, and even support, artificial ventilation. Meanwhile, dedicated sectioned electrodes could be integrated into gastric feeding tubes.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Faculty Institutions > sitem Center for Translational Medicine and Biomedical Entrepreneurship
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Scheidegger, Olivier, Häberlin, Andreas David Heinrich


600 Technology > 610 Medicine & health




BioMed Central




Pubmed Import

Date Deposited:

01 Feb 2023 10:03

Last Modified:

02 Feb 2023 22:46

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Uncontrolled Keywords:

Critical care Diaphragm activation Esophageal catheter Hospital mortality Intensive care unit Lung and diaphragm protective Phrenic nerve stimulation Transesophageal stimulation Ventilation induced diaphragmatic dysfunction





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