Central Hypoventilation; Long-term Ventilatory Assistance by Radiofrequency Electrophrenic Respiration

Glenn, William W. L.; Holcomb, Wade G.; Gee, J. Bernard L.; Rath, R

doi:10.1097/00000658-197010000-00020

Cited by 122 publications

(37 citation statements)

References 18 publications

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“…CONVENTIONAL DIAPHRAGM PACING.-Conventional phrenic nerve pacing generally requires a thoracotomy for electrode placement. Cervical electrode placement, while less invasive surgically, has been used in the past (37,44) but is presently discouraged for several reasons. In the presence of an accessory branch from a lower segment of the cervical spinal cord that joins the main trunk of the phrenic nerve in the lower neck region or thorax, cervical phrenic nerve stimulation may result in incomplete diaphragm activation (12,15).…”

Section: Equipment and Methods Of Applicationmentioning

confidence: 99%

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Inspiratory Muscle Pacing in Spinal Cord Injury: Case Report and Clinical Commentary

DiMarco

Onders

Ignagni

et al. 2006

The Journal of Spinal Cord Medicine

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Background/Objective: A significant fraction of patients with cervical spinal cord injury suffer from respiratory muscle paralysis and dependence on chronic mechanical ventilation. In selected patients, diaphragm pacing (DP) through electrical stimulation of the phrenic nerves provides an alternative to mechanical ventilation with significant advantages in life quality.Methods: A case report of an individual who successfully underwent DP using intramuscular diaphragm electrodes. A brief review of the state of the art of DP including the clinical benefits of DP, patient selection and evaluation, description of equipment, methods of transition from mechanical ventilation to DP, potential complications and side effects, long-term outcome, and potential future developments in this field is included.Results: Several available DP systems are available, including conventional ones in which electrodes are positioned directly on the phrenic nerves through thoracotomy and less invasive systems in which electrodes are placed within the diaphragm through laparoscopy. For patients with only unilateral phrenic nerve function, a combined intercostal and unilateral diaphragm pacing system is under development. Conclusions:In patients with ventilator-dependent tetraplegia, there are alternative methods of ventilatory support, which offer substantial benefits compared to mechanical ventilation. Med. 2006;29:95-108 J Spinal Cord

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Section: Equipment and Methods Of Applicationmentioning

confidence: 99%

“…In systems that require 2 receivers, they should be placed at least 15 cm apart. A more detailed discussion of the surgical procedure can be found in previous reviews (14,34,44).…”

Section: Equipment and Methods Of Applicationmentioning

confidence: 99%

Inspiratory Muscle Pacing in Spinal Cord Injury: Case Report and Clinical Commentary

DiMarco

Onders

Ignagni

et al. 2006

The Journal of Spinal Cord Medicine

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“…The published physiological results have been positive, 2,3,5,7 and it seems that neither the phrenic nerve nor the diaphragm suffers any degradation due to the un-physiological electrical stimulation. The user experiences reported have also been positive 4,5,[7][8][9][10][11] and are largely identical across countries.…”

Section: Introductionmentioning

confidence: 99%

“…This has been known for centuries, 1 but the technology for making phrenic nerve pacing a viable alternative to mechanical positive pressure ventilation is only four decades old. 2 Reports of long-time use in tetraplegic patients came in 1976. 3 Establishing phrenic nerve pacing consists of several steps: [2][3][4][5][6][7] at first the patient's phrenic nerve and diaphragm has to be tested to make sure that there is connection and sufficient contraction to secure adequate airflow.…”

Section: Introductionmentioning

confidence: 99%

Phrenic pacing compared with mechanical ventilation

Laub

Biering‐Sørensen

2017

Spinal Cord Ser Cases

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STUDY DESIGN: Comparable case series. OBJECTIVES: High-cervical spinal cord injury (SCI) may disrupt the ability to breathe sufficiently. To restore respiration a phrenic nerve pacer can be implanted. The aims of this study were to describe the use of phrenic nerve pacing in tetraplegics in Denmark and compare the users with a population of ventilator dependent tetraplegics. SETTING: Clinics for Spinal Cord Injuries, and Respiratory Centre East, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. METHODS: Nine tetraplegic individuals who had implantation of a phrenic nerve pacer and 16 home mechanical ventilator dependent tetraplegics met the inclusion criteria. Data were retrieved from medical records and a structured follow-up interview with seven individuals from each group. RESULTS: No significant differences were found when comparing age at injury, time since injury, length of hospitalization, incidence of pneumonia, number of pneumonia hospitalizations, number of tracheal suctions, speech quality and activities of daily living or quality of life. On the Short Form Health Survey (SF36) mental health summary the median for both users of phrenic nerve pacing and users of mechanical ventilation was one s.d. above the mean of a standard population. CONCLUSIONS: Nine people have had a phrenic nerve pacer implanted. They do not significantly differ from a group of home mechanical ventilator dependent tetraplegics on a number of performance measures, but both groups seem to have better quality of life than a standard population. (2017) Spinal Cord Series and Cases INTRODUCTIONSpinal cord injury (SCI) is one of the most devastating injuries a person can be the victim of. It renders the body sense-and motionless and incapacitates the autonomic nervous system including the loss of bladder, bowel and sexual function. The primary respiratory muscle is the diaphragm innervated by the phrenic nerve arising primarily from the C4 segment of the spinal cord. Any damage at or above C4 has the potential for destroying the link between the respiratory centers of the brain and the diaphragm. Thus, in the case of high-cervical SCI resulting in tetraplegia even the ability to breathe sufficiently may be disrupted.By applying an electrical current to the phrenic nerve, it is possible to make the diaphragm contract, and thus create an inspiration. This has been known for centuries, 1 but the technology for making phrenic nerve pacing a viable alternative to mechanical positive pressure ventilation is only four decades old.2 Reports of long-time use in tetraplegic patients came in 1976.

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“…Electroventilation has been used in patients with significant impairment of diaphragmatic function and chronic dependence on mechanical ventilation, such as those with high cervical injury (C1-C5), hypoventilation syndrome, amyotrophic lateral sclerosis (ALS) and others [1][2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

Technique for implanting intramuscular electrodes in the diaphragm by videolaparoscopy in pigs

et al. 2016

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PURPOSE:To describe a novel approach for implanting intramuscular electrodes in the diaphragm through videolaparoscopy. METHODS:We used twelve pigs for this videolaparoscopic technique, which permits at the same time to explore the diaphragm, to locate its motor points and to fix the electrodes in the diaphragm bilaterally. In this technique we used three trocars: one portal for a 10-mm 0° viewing angle laparoscope, one portal for the manipulation of structures and another for electrode implantation. RESULTS:All animals survived the procedure without pneumothorax/capnothorax or other complication. Implanted electrodes provided an appropriate interface between the muscle and the electrical current generator, and electroventilation was satisfactorily generated in all animals. CONCLUSION:This videolaparoscopic technique with three trocars enables the exploration and identification of motor points and an efficient fixation of one or two electrodes in each hemidiaphragm.

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Central Hypoventilation; Long-term Ventilatory Assistance by Radiofrequency Electrophrenic Respiration

Cited by 122 publications

References 18 publications

Inspiratory Muscle Pacing in Spinal Cord Injury: Case Report and Clinical Commentary

Inspiratory Muscle Pacing in Spinal Cord Injury: Case Report and Clinical Commentary

Phrenic pacing compared with mechanical ventilation

Technique for implanting intramuscular electrodes in the diaphragm by videolaparoscopy in pigs

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