Vagal Nerve Stimulation: A Potentially Useful Adjuvant to Treatment of Sepsis

Aim of review: The hyper-inflammatory response is the classical pathogenesis of sepsis course. It has been shown that efferent vagal nerve stimulation (VNS) can regulate inflammatory response through a combination of acetylcholine and special α7 nicotinic acetylcholine receptor expressed on macrophages, which is defined as the cholinergic anti-inflammatory pathway (CAP). Furthermore, therapeutic methods related to CAP have been studied on lots of pathologic conditions, such as sepsis, ischemia/reperfusion injury, pancreatitis and hemorrhagic shock, etc. The aim of this review is to provide the evidence that VNS may be an effective adjuvant treatment bringing benefits for prognosis of sepsis by controlling excessive inflammatory response.Methods: We searched literatures published in the Pubmed with keywords "inflammation", "sepsis" and "vagal nerve stimulation (VNS)" from January, 1986 to November, 2016, analyzed them and then assessed the evidence as to whether VNS may be an effective adjuvant for treatment of sepsis. In this review, the evidence regarding the role of hyper-inflammatory response in the pathogenesis of sepsis and inflammatory regulation of CAP will first be described. Then, the possible beneficial effects of VNS on inflammatory response of sepsis by modulating CAP will be provided.Recent findings: Sepsis is complex interactions between infecting microorganism and host's immune, inflammatory, and coagulation systems. The beneficial effects provided by CAP activation have been demonstrated on lots of pathologic conditions related to inflammation. Furthermore, VNS has been shown to promote the gastrointestinal motility and provide protection of intestinal barrier, reducing organ injury. In addition, VNS has been effectively used for treatment of some diseases in clinical practice.Summary: There is limited number of effective therapies available for septic patients. Because the CAP plays an important role in the regulation of inflammatory response, we consider that with the standard intensive care therapy, VNS may be an effective adjuvant treatment bringing benefits for prognosis of sepsis by controlling excessive inflammatory response. If efficiency of this new intervention is proved by clinical experiments, it may represent an exciting opportunity to develop novel therapeutics recovering unregulated inflammatory response in septic patients. Citation:  Gui-Zhen Yang, Fu-Shan Xue, Chao Sun, Xu Liao, Jian-Hua Liu. Vagal nerve stimulation: a potential useful adjuvant to treatment of sepsis. J Anesth Perioper Med 2017; x: x-x. doi: 10.24015/JAPM.2017.0012This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.