Importance of the adaptive properties of skeletal muscle in long-term electrophrenic stimulation of the diaphragm

Clinical experience reviewed elsewhere in this issue supports the use of electrical stimulation of the diaphragm via the phrenic nerve in selected patients in whom ventilation is inadequate, intermittent or absent. This paper represents a muscle biologist's view of some of the fundamental problems posed by this technique. It reviews the long-term changes that take place in skeletal muscles in response to chronic stimulation, and it indicates how these may be exploited in order to make electrophrenic respiration more effective and more acceptable both to the patient and to the clinical support team.