• Mariangela Pellegrini, Mélodie Parfait, and Martin Dres.
• Anesthesia, Operation and Intensive Care Medicine, Uppsala University Hospital.
• Curr Opin Crit Care. 2024 Nov 19.

Purpose Of ReviewIn the current review, we aim to highlight the evolving evidence on using diaphragm neurostimulation to develop lung and diaphragm protective mechanical ventilation.Recent FindingsPositive-pressure ventilation (PPV) causes stress and strain to the lungs which leads to ventilator-induced lung injury (VILI). In addition, PPV is frequently associated with sedatives that induce excessive diaphragm unloading which contributes to ventilator-induced diaphragmatic dysfunction (VIDD). The nonvolitional diaphragmatic contractions entrained by diaphragm neurostimulation generate negative pressure ventilation, which may be a beneficial alternative or complement to PPV. Although well established as a permanent treatment of central apnea syndromes, temporary diaphragm neurostimulation rapidly evolves to prevent and treat VILI and VIDD. Experimental and small clinical studies report comprehensive data showing that diaphragm neurostimulation has the potential to mitigate VIDD and to decrease the stress and strain applied to the lungs.SummaryScientific interest in temporary diaphragm neurostimulation has dramatically evolved in the last few years. Despite a solid physiological rationale and promising preliminary findings confirming a beneficial effect on the diaphragm and lungs, more studies and further technological advances will be needed to establish optimal standardized settings and lead to clinical implementation and improved outcomes.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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