Phrenic nerve stimulation: The Australian experience

Khong, Peter; Lazzaro, A.; Mobbs, Ralph J.

doi:10.1016/j.jocn.2009.06.012

Cited by 52 publications

(48 citation statements)

References 9 publications

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“…Two (16%) patients died, one (8%) patient paced part-time, and three (25%) patients stopped pacing. Recently, Khong et al [24] published an Australian series of 19 patients. Of those, 14 required phrenic nerve pacing due to quadriplegia, one had central hypoventilation syndrome, one had encephalitis, and the information on the remaining three was not known.…”

Section: Outcome Data In Adultsmentioning

confidence: 99%

“…The ideal candidates for pacing with a phrenic nerve stimulator are the patients with complete cervical spine injuries at C1 and C2 level, congenital or acquired central alveolar hypoventilation syndrome, brainstem injury (tumor, trauma, bleed, infarct), or basilar meningitis [20,24,27]. Diaphragmatic pacing has been used for other indications as Arnold Chiari malformation, meningomyelocele, neurofibromatosis (with multiple meningiomas), complete tetraplegia , patients with C3-C4 incomplete fracture, C4-C5 fracture with ascending paralysis to C2-C3 level, radiation induced phrenic nerve injury [24,26,28]. In a twenty-year experience of phrenic nerve stimulation for diaphragmatic pacing, Glann and colleague used the pacing in 2% of patients with chronic obstructive pulmonary disease (COPD).…”

Section: Indicationmentioning

confidence: 99%

“…The electrode is positioned below the nerve and sutured. The leads are then brought through the thoracic cavity and tunneled into the subcutaneous pocket inferior to the 12 th rib and the receiver is placed into the pocket [24,41]. During surgery, after securing the electrodes and connecting to the receiver, the device is tested to ensure good contact with the nerve and stimulation via the receiver results in good contraction of the diaphragm.…”

Section: Surgical Implantation Techniquesmentioning

confidence: 99%

“…In the Australian study, eight out of 19 patients had repeat operations for replacement/reimplantation of hardware. The original I-107 receiver had a life span of three to five years, whereas the battery life of the current receiver is as long as that of the patient [24]. In the pediatric population of a study by Shaul et al [40], two patients developed postoperative atelectasis, and one patient had pneumonia.…”

Section: Complicationsmentioning

confidence: 99%

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Diaphragmatic Pacemaker

Surani¹

2011

Modern Pacemakers - Present and Future

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Section: Outcome Data In Adultsmentioning

confidence: 99%

Section: Indicationmentioning

confidence: 99%

Section: Surgical Implantation Techniquesmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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Diaphragmatic Pacemaker

Surani¹

2011

Modern Pacemakers - Present and Future

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“…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. This is done by applying external current to the nerve transcutaneous on the neck, while measuring diaphragm contraction with fluoroscopy or ultrasound.…”

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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A 2‐mA charge‐balanced neurostimulator in 0.18‐μm/1.8 V standard CMOS process

Hosseinnejad

Katebi

Erfanian

et al. 2022

Circuit Theory & Apps

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This paper presents a programmable neurostimulator 4 Â V DD with 7.2 V operating voltage in a 0.18-μm/1.8 V CMOS process. The output voltage compliance exceeds 6.2 V. A current gain control is designed to adjust bias current.A 5-bit current mode digital-to-analog converter (DAC) is used to set delivered current in current driver. A high output impedance current mirror is designed to guarantee charge balancing. The charge mismatch after biphasic stimulation is about 0.14%. Moreover, current mirrors are turned off after stimulation to decrease power consumption. The headroom voltage is about 1 V for all the voltage drivers and the current mirrors. The proposed neurostimulator occupies 0.95 Â 0.95 mm 2 with a maximum current range of 0-2000 μA and a power consumption less than 60 μW.

show abstract

Phrenic nerve stimulation: The Australian experience

Cited by 52 publications

References 9 publications

Diaphragmatic Pacemaker

Diaphragmatic Pacemaker

Phrenic pacing compared with mechanical ventilation

A 2‐mA charge‐balanced neurostimulator in 0.18‐μm/1.8 V standard CMOS process

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