Total Ventilatory Support in a Quadriplegic Patient with Radiofrequency Electrophrenic Respiration

Glenn, William W. L.; Holcomb, Wade G.; McLaughlin, Albert J.; O'Hare, James M.; Hogan, James; Yasuda, R

doi:10.1056/nejm197203092861004

Cited by 100 publications

(18 citation statements)

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“…2) est la technique « historique » [4,11]. Elle repose sur la transmission par radiofréquence, par l'intermédiaire d'antennes, à un récepteur implanté relié à des électrodes phréniques, d'éner-gie et d'informations produites et modulées par un stimulateur externe (Atrostim ® , Atrotech, Tampere, Finlande).…”

Section: Stimulation Phrénique Intrathoraciqueunclassified

“…Duchenne De Boulogne décrit en détail la technique de la stimulation phré-nique au cou et en suggère des applications thérapeutiques, dans la rééducation des paralysies saturniennes par exemple [3]. À l'ère moderne, les premières applications cliniques de la stimulation phrénique implantée datent des années 1970 [4]. En France, une première activité dans ce domaine est notée dans les années 1980, par une équipe de Berck [5].…”

Section: Introductionunclassified

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La stimulation phrénique implantée

2010

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La stimulation phrénique implantée est une technique qui permet de restaurer une autonomie ventilatoire à des patients présentant un trouble de commande respiratoire induisant une dépendance ventilatoire. C'est le cas, par exemple, des patients tétraplégiques à la suite d'une lésion médullaire haute et des patients atteints d'un syndrome d'hypoventilation centrale congénitale. Les explorations élec-trophysiologiques du diaphragme permettent de sélectionner les candidats en confirmant en outre la réalité de l'atteinte de la commande respiratoire centrale mais également l'intégrité des nerfs phréniques et du diaphragme. Actuellement, deux techniques de stimulation phrénique sont disponibles en France (stimulation quadripolaire intrathoracique et stimulation bipolaire intradiaphragmatique). Ces deux techniques ont permis le sevrage du ventilateur externe et ont apporté un bénéfice franc en termes de qualité de vie aux patients depuis de nombreuses années. De ce fait, un des dispositifs (stimulation phrénique intradiaphragmatique) a obtenu en 2009 l'inscription sur la liste des prestations et produits remboursables (LPPR) en France. En réanimation, le futur verra peut-être la stimulation phrénique implantée transitoire trouver une place dans la prévention des complications respiratoires de certaines chirurgies, et de l'atrophie diaphragmatique liée à la ventilation prolongée. Pour citer cette revue : Réanimation 20 (2011). Mots clés Stimulation phrénique · Tétraplégique · Dépendance ventilatoireAbstract The implanted phrenic nerve stimulation is a technique restoring the spontaneous breathing in patients with a failing respiratory command, which leads to a dependency on mechanical ventilation. This technique may particularly involve quadriplegic patients with a high-level spinal cord injury and patients with congenital central hypoventilation syndrome. The electrophysiological diaphragm investigations allow a better patient selection, assessing in one hand a definite problem with central respiratory command and on the other hand the integrity of phrenic nerves. To date, two different phrenic stimulation techniques are available in France: the quadripolar intra-thoracic stimulation and the bipolar intra-diaphragmatic stimulation. Both techniques allow patients to be weaned off their mechanical ventilator, improving dramatically their quality of life. In fact, one of the systems (phrenic intra-diaphragmatic stimulation) was granted reimbursement in France in 2009 and is now on the social security list of reimbursed products. In the future, the phrenic intra-diaphragmatic stimulation may find its place in the intensive care unit with temporal use following surgeries leading to specific respiratory complications as well as diaphragmatic atrophy induced by prolonged mechanical ventilation.

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Section: Stimulation Phrénique Intrathoraciqueunclassified

Section: Introductionunclassified

La stimulation phrénique implantée

2010

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“…Through electrical stimulation of the muscles of respiration, these neural prostheses can often allow users to discontinue mechanical ventilation, reducing it s numerous side effects and enhancing the independence of the user. The most widely used respiratory neural prosthesis uses electrical stimulation of the phrenic nerve (via a nerve cuff electrode) to cyclically activate the paralyzed diaphragm muscle to produce respiration (Baer et al, 1990;Chervin & Guilleminault, 1997;Creasey et al , 1996;Dobelle, Angelo, & Goetz, 1994;Elefteriades, Hogan, Handler, & Loke, 1992;Glenn, 1972;Glenn et al, 1986;Mayr, Bijak, & Girsch, 1993;Miller, Farmer, Stuart, & Apple, 1990). More than 1,000 individuals with high-level cervical (C3 or above) spinal cord injury and central alveolar hypoventilation have successfully used such phrenic pacing systems.…”

Section: Komentioning

confidence: 99%

Neuroprosthetic Applications of Electrical Stimulation

Grill

Kirsch

2000

Assistive Technology

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Neural prostheses are a developing technology that use electrical activation of the nervous system to restore function to individuals with neurological impairment. Neural prostheses function by electrical initiation of action potentials in nerve fibers that carry the signal to an endpoint where chemical neurotransmitters are released, either to affect an end organ or another neuron. Thus, in principle, any end organ under neural control is a candidate for neural prosthetic control. Applications have included stimulation in both the sensory and motor systems and range in scope from experimental trials with single individuals to commercially available devices. Outcomes of motor system neural prostheses include restoration of hand grasp and release in quadriplegia, restoration of standing and stepping in paraplegia, restoration of bladder function (continence, micturition) following spinal cord injury, and electrophrenic respiration in high-level quadriplegia. Neural prostheses restore function and provide greater independence to individuals with disability.

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“…To overcome this, Taira first described the use of spinal cord stimulator for diaphragmatic pacing in 2003 with good results, [1] reproduced subsequently by others. [2][3][4] We describe the use of this device in a case of central neurogenic hypoventilation. To the best of our knowledge, this is first such case of PNS using the spinal cord stimulator in India.…”

Section: Introductionmentioning

confidence: 99%

Unilateral phrenic nerve stimulation for neurogenic hypoventilation in Arnold Chiari malformation

Garg¹

2017

IJNS

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A 25-year-old patient presented with progressive quadriparesis of 2 months duration with shallow breathing. Magnetic resonance imaging (MRI) was suggestive of Arnold-Chiari malformation type I with extensive syringomyelia and bulbia [ Figure 1]. Foramen magnum decompression with duraplasty was performed. Post-operatively, neurological recovery was uneventful except for prolonged ventilator support and delayed weaning over 2 weeks. At the time of discharge, patient was ambulant with support, breathing spontaneously with normal arterial blood gas (ABG) results.Patient was readmitted to the emergency department after 1 month with a history of seizures, altered sensorium of few hours' duration and shallow breathing. His ABG was suggestive of severe respiratory acidosis (pCO 2 91 mmHg, pO 2 71.2 mmHg, pH 7.012). Following elective ventilation, the blood gases were normalized and patient regained sensorium. Detailed history given by relatives suggested very few respiratory movements during sleep with progressive drowsiness during daytime and gradual unconsciousness. A repeat MRI revealed complete resolution of syrinx with decompressed foramen magnum [ Figure 2]. Tracheostomy was performed to facilitate early weaning. Continuous monitoring revealed a trend of significant reduction in respiratory rate, progressive buildup of end-tidal CO 2 and deterioration of blood gases during sleep, which

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Total Ventilatory Support in a Quadriplegic Patient with Radiofrequency Electrophrenic Respiration

Cited by 100 publications

References 8 publications

La stimulation phrénique implantée

La stimulation phrénique implantée

Neuroprosthetic Applications of Electrical Stimulation

Unilateral phrenic nerve stimulation for neurogenic hypoventilation in Arnold Chiari malformation

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