Evidence map›Paper›PMID 41764523›Full record

Trial reportCritical care (London, England)2026

Diaphragm neurostimulation mitigates the adverse cardiopulmonary effects of positive pressure ventilation.

Idunn S Morris, Thiago Bassi, Andrea Castellvi-Font, Andaleeb Iftikhar, Georgiana Roman-Sarita, Catherine A Bellissimo, Paweenuch Bootjeamjai, Zhanqi Zhao, Viral Thakkar, Nawzer Mehta and 4 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05465083 (Feasibility of Transvenous Phrenic Nerve Stimulation for Diaphragm Protection in Acute Respiratory Failure), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05465083 nacompletednot on this map

Feasibility of Transvenous Phrenic Nerve Stimulation for Diaphragm Protection in Acute Respiratory Failure: the STIMULUS I Clinical Trial

TypeinterventionalSponsorUniversity Health Network, TorontoRan2023 to 2023Enrolled20ConditionsAcute Hypoxemic Respiratory Failure, Diaphragm Injury, Lung InjuryArmsLungpacer AeroPace Protect System
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Idunn S MorrisDepartment of Physiology, University of Toronto, ON, Canada. Idunn.Morris@sydney.edu.au.
Thiago BassiInterdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada.
Andrea Castellvi-FontDepartment of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada.
Andaleeb IftikharDepartment of Physiology, University of Toronto, ON, Canada.
Georgiana Roman-SaritaDepartment of Respiratory Therapy, University Health Network, Toronto, ON, Canada.
Catherine A BellissimoToronto General Hospital Research Institute, Toronto, ON, Canada.
Paweenuch BootjeamjaiDepartment of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyFaculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Zhanqi ZhaoSchool of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China.
Viral ThakkarLungpacer Medical USA Inc., Exton, PA, USA.
Nawzer MehtaLungpacer Medical USA Inc., Exton, PA, USA.
John GrantonInterdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada.
Laurent BrochardInterdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada.
Niall D FergusonDepartment of Physiology, University of Toronto, ON, Canada.
Ewan C GoligherDepartment of Physiology, University of Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPositive pressure ventilation has multiple adverse cardiopulmonary effects leading to impaired lung mechanics and hemodynamic performance. Controlled levels of diaphragm activity may mitigate these. The objectives of the study were to assess the effect of varying levels of diaphragm neurostimulation on respiratory mechanics and hemodynamics during positive pressure ventilation and to establish whether these effects depend on the level of applied positive end-expiratory pressure (PEEP).

methodsPatients enrolled in a clinical trial of diaphragm neurostimulation underwent a nested randomized cross-over study assessing the effect of passive ventilation alone or in combination with three levels of diaphragm neurostimulation, performed at two levels of PEEP. Respiratory mechanics, distribution of ventilation, and hemodynamics were assessed.

resultsSixteen patients were included. Diaphragm neurostimulation increased ventilation to the dorsal lung regions in a dose-dependent fashion (median 63% vs. 43% of tidal volume, p < 0.001) whereas increasing PEEP had a much more limited effect (median 43% vs. 43%, p = 0.05). Diaphragm neurostimulation increased end-expiratory lung volume by 617 mL and decreased respiratory system elastance from 1.4 to 1.2 cm H2O/(mL/kg), but only at higher PEEP (p = 0.025 and 0.021 for interaction, respectively). Neurostimulation significantly increased cardiac index (2.4 vs. 2.7 L/min/m2, p = 0.031) without increasing pulmonary artery transmural pressure (p = 0.26). In the absence of neurostimulation, increasing PEEP tended to decrease cardiac index (2.4 vs. 2.1 L/min/m2, p = 0.28).

conclusionsDiaphragm neurostimulation can mitigate the adverse cardiopulmonary effects of positive pressure ventilation. When combined with higher PEEP, diaphragm neurostimulation enhances dorsal lung recruitment without impairing hemodynamics.

trial registrationThe STIMULUS trial (NCT05465083) was prospectively registered at clinicaltrials.gov (July 2022).

Indexed as

DiaphragmElectric Stimulation TherapyPositive-Pressure RespirationAgedCross-Over StudiesFemaleHemodynamicsHumansMaleMiddle AgedRespiratory MechanicsAcute cor pulmonaleAcute respiratory failureCardiac dysfunctionDiaphragm neurostimulationHemodynamic performanceLung protective ventilationVentilator induced lung injury

Identifiers

PMID41764523
PMCPMC13085342

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.