Application of a cervical stimulating apparatus for bilateral transcutaneous phrenic nerve stimulation

Transcutaneous bilateral phrenic nerve stimulation (tPNS) is frequently used to assess diaphragmatic function in humans. Commonly, stimulation is performed with hand-held electrodes; however, these are unsuitable for studies requiring repeated PNS and where recruitment of rib cage and neck muscles may shift the probes in relation to the nerves. In this study we describe the design of a cervical neck brace and electrode probes that maintain stimulating electrodes in constant position relative to the phrenic nerves and facilitates studies requiring repeated maximal PNS. The effectiveness of the apparatus was examined by 1) reviewing the reproducibility of the transdiaphragmatic pressure response to 0.1 ms tPNS (PdiT) at relaxed functional residual capacity in four subjects studied on 25 +/- 8 (SD) occasions (> or = 24 h apart) over a 4-yr period, and 2) measuring peak-to-peak amplitude of the left and right diaphragmatic compound muscle action potentials (surface electrodes) during two prolonged studies (38 +/- 9 min) in each subject, when tPNS was performed during repeated submaximal and maximal inspiratory efforts. PdiT was reproducible in each subject when measured repeatedly within a single study [coefficient of variation (CV) of 3.8 +/- 0.8%] and over separate days (CV of 11.5 +/- 3.5%). The peak-to-peak amplitudes of the left and right compound muscle action potentials were also reproducible (CV of 8.4 +/- 4.3 and 8.4 +/- 2.9%, respectively) and independent of the degree of effort. The apparatus appears effective for the maintenance of maximal stimulation under varied conditions for long periods and provides reproducible measurements of PdiT both within and between studies.