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1 UPRES EA 2397, Université Pierre et Marie Curie Paris VI, 75013 Paris; 2 Service de Physiologie Respiratoire et Sportive, Hôpital Charles Nicolle, Centre Hospitalier Universitaire, Rouen 76000; 3 Service d'Explorations Fonctionnelles Respiratoires, and 4 Laboratoire de Physiopathologie Respiratoire, Service de Pneumologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013 Paris; and 5 Laboratoire d'Explorations Fonctionnelles Respiratoires, Centre Hospitalier Universitaire La Cavale Blanche, 29200 Brest, France
Phrenic nerve stimulation, electrical (ES) or from cervical magnetic stimulation (CMS), allows one to assess the diaphragm contractile properties and the conduction time of the phrenic nerve (PNCT) through recording of an electromyographic response, traditionally by using surface electrodes. Because of the coactivation of extradiaphragmatic muscles, signal contamination can jeopardize the determination of surface PNCTs. To address this, we compared PNCTs with ES and CMS from surface and needle diaphragm electrodes in five subjects (10 phrenic nerves). At a modified recording site, lower and more anterior than usual (lowest accessible intercostal space, costochondral junction) with electrodes 2 cm apart, surface and needle PNCTs were similar (CMS: 6.0 ± 0.25 ms surface vs. 6.2 ± 0.13 ms needle, not significant). Electrodes recording the activity of the most likely sources of signal contamination, i.e., the serratus anterior and pectoralis major, showed distinct responses from that of the diaphragm, their earlier occurrence strongly arguing against contamination. With ES and CMS, apparently uncontaminated signals could be consistently recorded from surface electrodes.
phrenic nerve; accessory phrenic nerve; cervical magnetic stimulation; electromyography
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