Extended use of diaphragm pacing in patients with unilateral or bilateral diaphragm dysfunction: A new therapeutic option

Onders, Raymond P.; Elmo, MaryJo; Kaplan, Cindy; Katirji, Bashar; Schilz, Robert

doi:10.1016/j.surg.2014.07.021

Cited by 48 publications

(32 citation statements)

References 19 publications

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“…The ideal candidates for phrenic nerve pacing are patients with upper level spinal cord injury that are still ventilator dependent at least three months after the initial injury: the beneficial effects of pacing were mostly demonstrated in this population, with the majority of patients being liberated from ventilatory support [171,172,173]. Successful cases have also been reported with patients with congenital hypoventilation [174,175,176] syndrome and other neurological diseases [177]. Some data originally suggested a possible benefit of phrenic nerve pacing in patients with ALS [178,179], but two recent, prospective randomized trials evaluating the effect of this intervention in this setting had to be prematurely stopped because of a decrease in survival in the treatment arms [180,181].…”

Section: Therapeutic Managementmentioning

confidence: 99%

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé

Dres

2016

JCM

157

109

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The diaphragm is the main inspiratory muscle, and its dysfunction can lead to significant adverse clinical consequences. The aim of this review is to provide clinicians with an overview of the main causes of uni- and bi-lateral diaphragm dysfunction, explore the clinical and physiological consequences of the disease on lung function, exercise physiology and sleep and review the available diagnostic tools used in the evaluation of diaphragm function. A particular emphasis is placed on the clinical significance of diaphragm weakness in the intensive care unit setting and the use of ultrasound to evaluate diaphragmatic action.

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Section: Therapeutic Managementmentioning

confidence: 99%

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé

Dres

2016

JCM

157

109

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“…The management of post-SCI respiratory dysfunction using open-loop muscle/nerve FES (e.g. diaphragm pacing (Gonzalez-Bermejo et al, 2015; Onders, 2012; Onders et al, 2014; Posluszny et al, 2014)), represents a significant improvement over alternative assisted-ventilation strategies. Ongoing work in this area has revealed that it not only maintains ventilation, but may also contribute to plasticity and lasting functional recovery (Posluszny et al, 2014).…”

Section: Therapeutically Shaping Respiratory Neuroplasticitymentioning

confidence: 99%

Enhancing neural activity to drive respiratory plasticity following cervical spinal cord injury

Hormigo

Zholudeva

Spruance

et al. 2017

Experimental Neurology

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Cervical spinal cord injury (SCI) results in permanent life-altering sensorimotor deficits, among which impaired breathing is one of the most devastating and life-threatening. While clinical and experimental research has revealed that some spontaneous respiratory improvement (functional plasticity) can occur post-SCI, the extent of the recovery is limited and significant deficits persist. Thus, increasing effort is being made to develop therapies that harness and enhance this neuroplastic potential to optimize long-term recovery of breathing in injured individuals. One strategy with demonstrated therapeutic potential is the use of treatments that increase neural and muscular activity (e.g. locomotor training, neural and muscular stimulation) and promote plasticity. With a focus on respiratory function post-SCI, this review will discuss advances in the use of neural interfacing strategies and activity-based treatments, and highlights some recent results from our own research.

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“…Implantation of diaphragm pacemakers for hemidiaphragmatic paralysis was first reported by Onders et al, who demonstrated an improvement in respiratory function in 62% of patients. 26…”

Section: Discussionmentioning

confidence: 99%

Long-Term Follow-Up after Phrenic Nerve Reconstruction for Diaphragmatic Paralysis: A Review of 180 Patients

Kaufman

Elkwood

Brown

et al. 2016

J reconstr Microsurg

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Phrenic nerve reconstruction has been evaluated as a method of restoring functional activity and may be an effective alternative to diaphragm plication. Longer follow-up and a larger cohort for analysis are necessary to confirm the efficacy of this procedure for diaphragmatic paralysis. A total of 180 patients treated with phrenic nerve reconstruction for chronic diaphragmatic paralysis were followed for a median 2.7 years. Assessment parameters included: 36-Item Short Form Health Survey (SF-36) physical functioning survey, spirometry, chest fluoroscopy, electrodiagnostic evaluation, a five-item questionnaire to assess specific functional issues, and overall patient-reported outcome. Overall, 134 males and 46 females with an average age of 56 years (range: 10-79 years) were treated. Mean baseline percent predicted values for forced expiratory volume in 1 second, forced vital capacity, vital capacity, and total lung capacity, were 61, 63, 67, and 75%, respectively. The corresponding percent improvements in percent predicted values were: 11, 6, 9, and 13% ( ≤ 0.01; ≤ 0.01; ≤ 0.05; ≤ 0.01). Mean preoperative SF-36 physical functioning survey scores were 39%, and an improvement to 65% was demonstrated following surgery ( ≤ 0.0001). Nerve conduction latency, improved by an average 23% ( ≤ 0.005), and there was a corresponding 125% increase in diaphragm motor amplitude ( ≤ 0.0001). A total of 89% of patients reported an overall improvement in breathing function. Long-term assessment of phrenic nerve reconstruction for diaphragmatic paralysis indicates functional correction and symptomatic relief.

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Extended use of diaphragm pacing in patients with unilateral or bilateral diaphragm dysfunction: A new therapeutic option

Cited by 48 publications

References 19 publications

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Enhancing neural activity to drive respiratory plasticity following cervical spinal cord injury

Long-Term Follow-Up after Phrenic Nerve Reconstruction for Diaphragmatic Paralysis: A Review of 180 Patients

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