Ventilatory Support by Pacing of the Conditioned Diaphragm in Quadriplegia

Glenn, William W. L.; Hogan, James; Loke, Jacob; Ciesielki, T. E.; Phelps, Mildred L.; Rowedder, R.

doi:10.1097/00132586-198508000-00003

Cited by 20 publications

(37 citation statements)

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“…The tracheostomy tube was plugged or the tracheostoma was lost in patients on PNS. Most patients were referred from hospitals that provide primary care and rehabilitation for SCI, but have no possibility to check the function of phrenic nerves and diaphragm muscles, cannot implant a PNS and cannot condition 5 the muscle. The function of phrenic nerves and diaphragm muscles was ascertained by neurophysiologic and fluoroscopic/sonographic studies.…”

Section: Methodsmentioning

confidence: 99%

“…1,2 However, electroventilation 3 has become a choice again through its modern versions such as diaphragm pacing (DP), 4,5 carousel stimulation (CS) 6 and four-pole-sequential phrenic nerve stimulation (PNS). 7 In electroventilation, an electrical system rhythmically stimulating the phrenic nerves takes over for the malfunctioning or inaccessible respiratory centre; a normal phrenic nerve and normal diaphragm muscle are prerequisites.…”

Section: Introductionmentioning

confidence: 99%

“…15 Therefore, we can give only the opinions of patients and doctors, like previous authors did. 5,[9][10][11][12][13]19 Patients and their doctors found the quality of life better with PNS than with MV: patients on PNS showed more selfconfidence and no one wanted to return to MV. Patients on MV frequently regretted not to be suitable for PNS.…”

mentioning

confidence: 99%

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Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

et al. 2008

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Study design: Prospective clinical study of two treatments. Objective: To compare mechanical ventilation (MV) with phrenic nerve stimulation (PNS) for treatment of respiratory device-dependent (RDD) spinal cord-injured (SCI) patients. Setting: Department for spinal cord-injured patients of an insurance-company-run trauma hospital in Hamburg, Germany. Methods: Prospective data collection of treatment-related data over 20 years. Results: In total, 64 SCI-RDD patients were treated during the study period. Of these, 32 of the patients with functioning phrenic nerves and diaphragm muscles were treated with PNS and 32 patients with destroyed phrenic nerves were mechanically ventilated. Incidence of respiratory infections (RIs per 100 days) prior to use of final respiratory device was equal in both groups, that is (median (interquartile range)) 1.43 (0.05-3.92) with PNS and 1.33 (0.89-2.21) with MV (P ¼ 0.888); with final device in our institution it was 0 (0-0.92) with PNS and 2.07 (1.49-4.19) with MV (Po0.001); at final location it was 0 (0-0.02) with PNS and 0.14 (0-0.31) with MV (Po0.001). Thus, compared to MV, respiratory treatment with PNS significantly reduces frequency of RI. Quality of speech is significantly better with PNS. Nine patients with PNS, but only two with MV, were employed or learned after rehabilitation (P ¼ 0.093). The primary investment in the respiratory device is higher with PNS, but it can be paid off in our setting within 1 year because of the reduced amount of single use equipment, easier nursing and fewer RIs compared to MV. Conclusions: PNS instead of MV for treatment of SCI-RDD reduces RIs, running costs of respiratory treatment and obviously improves patients' quality of life.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

et al. 2008

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“…If all results are within normal limits and the shift at supramaximum stimulation on the left is remarkably larger than the contraction during spontaneous breathing, implantation would be worthwhile on both sides. Long term full-term diaphragmatic pacing 5 or phrenic nerve stimulation 6 is possible after conditioning of the diaphragm muscle.…”

Section: Management Imentioning

confidence: 99%

Management of respiratory problems unique to high tetraplegia

et al. 1999

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“…Bilateral diaphragmatic paralysis (BDP) is a rare disorder, which can be secondary to spinal cord injury [1], motor neuron disease, myopathy [2], noninfectious polyneuropathy, infection [3], iced saline cardioplegia performed during cardiac surgery [4], or idiopathic causes [3]. Although BDP has been well described, the condition is generally under-recognized, and diagnosis is frequently delayed, especially in a ventilator-dependent patient [5].…”

mentioning

confidence: 99%

Bilateral diaphragmatic paralysis--a rare cause of acute respiratory failure managed with nasal mask bilevel positive airway pressure (BiPAP) ventilation

Lin¹,

Liaw²,

Huang³

et al. 1997

Eur Respir J

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A 68 yr old woman presented with acute respiratory failure. She was suspected of having a phrenic-diaphragmatic impairment, without evidence of an intrinsic lung disease or generalized neuromuscular disorder, after 3 weeks of prolonged mechanical ventilation.A series of studies, including fluoroscopy, phrenic nerve stimulation test and diaphragmatic electromyography, was performed before the diagnosis of bilateral diaphragmatic paralysis (BDP) was confirmed. The patient was successfully weaned from the conventional mechanical ventilator, and was placed on nasal mask bi-level positive airway pressure (BiPAP) ventilation.A high degree of clinical suspicion of bilateral diaphragmatic paralysis should always be raised in patients suffering respiratory failure without definite predisposing factors. Weaning with noninvasive nasal mask ventilation should be tried first instead of direct tracheostomy.

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Ventilatory Support by Pacing of the Conditioned Diaphragm in Quadriplegia

Cited by 20 publications

References 0 publications

Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

Management of respiratory problems unique to high tetraplegia

Bilateral diaphragmatic paralysis--a rare cause of acute respiratory failure managed with nasal mask bilevel positive airway pressure (BiPAP) ventilation

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