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R. Onders - One of the best experts on this subject based on the ideXlab platform.
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Long-term experience with Diaphragm Pacing for traumatic spinal cord injury: Early implantation should be considered.
Surgery, 2018Co-Authors: R. Onders, Maryjo Elmo, Cindy Kaplan, Robert Schilz, Bashar Katirji, Glen TinkoffAbstract:Background Cervical spinal cord injury can result in catastrophic respiratory failure requiring mechanical ventilation with high morbidity, mortality, and cost. Diaphragm Pacing was developed to replace/decrease mechanical ventilation. We report the largest long-term results in traumatic cervical spinal cord injury. Methods In this retrospective review of prospective institutional review board protocols, all patients underwent laparoscopic Diaphragm mapping and implantation of electrodes for Diaphragm strengthening and ventilator weaning. Results From 2000 to 2017, 92 patients out of 486 Diaphragm Pacing implants met the criteria. The age at time of injury ranged from birth to 74 years (average: 27 years). Time on mechanical ventilation was an average of 47.5 months (range, 6 days to 25 years, median = 1.58 years). Eighty-eight percent of patients achieved the minimum of 4 hours of Pacing. Fifty-six patients (60.8%) used Diaphragm Pacing 24 hours a day. Five patients had full recovery of breathing with subsequent Diaphragm Pacing removal. Median survival was 22.2 years (95% confidence interval: 14.0–not reached) with only 31 deaths. Subgroup analysis revealed that earlier Diaphragm Pacing implantation leads to greater 24-hour use of Diaphragm Pacing and no need for any mechanical ventilation. Conclusion Diaphragm Pacing can successfully decrease the need for mechanical ventilation in traumatic cervical spinal cord injury. Earlier implantation should be considered.
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Diaphragm Pacing Could Have Efficacy for Sleep Condition in Patients with Amyotrophic Lateral Sclerosis
Journal of Neurology and Neuroscience, 2018Co-Authors: Hisashi Ito, R. Onders, Shigeru Fukutake, Sanae Odake, Shunsaku Kohriki, Jun Kawachi, Tetsumasa KameiAbstract:Background: To investigate the efficacy of electrical Diaphragm Pacing (DP) for sleep condition in patients with amyotrophic lateral sclerosis (ALS). Method: We investigated 5 Japanese ALS patients without positive-pressure mechanical ventilation (3 men and 2 women, aged 59.6 ± 9.6 years). All of them were implanted NeuRx RA/4 Diaphragm Pacing System R (NeuRx) in the Diaphragm laparoscopically. We assessed physical status and polysomnographic recordings before implantation and after 6 months of conditioning with DP turned on. Results: 4 patients completed the evaluation. Sleep condition showed the tendency to improve far from getting worse despite of deterioration of physical status and respiratory function. Conclusion: DP with NeuRx might assist the sleep condition in ALS patients at least in 6 months of follow up.
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NOTES Transgastric Diaphragm Pacing
Clinical Gastroenterology, 2017Co-Authors: R. OndersAbstract:Mechanical ventilation (MV) is a life-sustaining treatment in patients who are unable to maintain spontaneous ventilation. Failure to wean (FTW) from MV, or prolonged ventilation results in significant morbidity, mortality, and health care costs. Diaphragm Pacing (DP) was initially developed to provide natural negative pressure ventilation in spinal cord injured (SCI) patients on MV. Its use has since expanded to ALS patients, as well as in critically ill patients to shorten MV time. A new technical development was that of a temporary and removable electrode. Since our group has experience with bedside NOTES with PEG rescue, we hypothesize that NOTES placement of DP electrodes is technically feasible and safe.
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An Autopsy Case of Amyotrophic Lateral Sclerosis with Diaphragm Pacing.
Internal medicine (Tokyo Japan), 2016Co-Authors: Hisashi Ito, R. Onders, Sanae Odake, Shunsaku Kohriki, Jun Kawachi, Tetsumasa Kamei, Masayuki Nakano, Riki Okeda, Fumihito YoshiiAbstract:Respiratory insufficiency is a critical problem in amyotrophic lateral sclerosis (ALS) patients. We herein present the case of an autopsied patient with sporadic ALS who underwent Diaphragm Pacing (DP). The pathology showed several localized adhesions with a markedly atrophied Diaphragm. A marked loss of motor neurons with Bunina bodies and phosphorylated TDP-43 positive inclusions was found in the spinal cord and primary motor cortex. Mild hyalinization and a few multinucleated giant cells were present around the electrode tracks in the Diaphragm. However, no infiltration of inflammatory cells was detected. Our findings suggest that full-time DP might not cause severe damage to adjacent Diaphragm tissue.
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Diaphragm Pacing as a Rehabilitative Tool for Patients With Pompe Disease Who Are Ventilator-Dependent: Case Series.
Physical therapy, 2016Co-Authors: Barbara K. Smith, R. Onders, Lawrence Lottenberg, David D. Fuller, A. Daniel Martin, Saleem Islam, Lee Ann Lawson, Barry J. ByrneAbstract:Background and Purpose Pompe disease is an inherited disorder notable for severe, progressive ventilatory compromise. Although ventilatory failure has been attributed to myofiber dysfunction secondary to Diaphragmatic glycogen accumulation, neural involvement of the phrenic motor system is also a prominent feature. Direct Diaphragm Pacing supplements respiratory function in other disorders of the phrenic motor system. Accordingly, it is hypothesized that augmented neuromuscular activity via Diaphragm Pacing would promote weaning from mechanical ventilation in patients with Pompe disease who are unresponsive to conventional, muscle-directed treatments. Case Description Three patients with Pompe disease developed Diaphragm paresis that resulted in chronic mechanical ventilation dependence. After preoperative inspiratory muscle strengthening exercises failed to improve function, fine-wire Pacing electrodes were laparoscopically implanted into the Diaphragm. Diaphragm conditioning was initiated the first postoperative week and consisted of gradual increases in stimulation parameters, lengthening of stimulation sessions, and ventilator weaning. Ventilation and intramuscular electromyographic activity were recorded periodically during conditioning to quantify Diaphragm neuromuscular function. Outcomes During paced breathing without mechanical ventilation, tidal volumes increased, and 2 patients were weaned from daytime ventilator dependence within the first 3 months of Pacing, which has been sustained over the long-term. A third patient reduced reliance on daytime ventilation, but weaning was delayed by malacia of the large airways. In all patients, Pacing appeared to facilitate spontaneous phrenic motor unit activity during independent breathing without ventilator or pacer support. Discussion The findings are consistent with the view that Diaphragm Pacing has potential rehabilitative value to reduce reliance on mechanical ventilation in people with Pompe disease, but further study is needed. Diaphragm Pacing represents a paradigm shift in the management of respiratory insufficiency for Pompe disease that warrants further controlled examination.
S. Schomisch - One of the best experts on this subject based on the ideXlab platform.
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Diaphragm Pacing with natural orifice transluminal endoscopic surgery: potential for difficult-to-wean intensive care unit patients
Surgical Endoscopy, 2007Co-Authors: R. Onders, M. F. Mcgee, J. Marks, A. Chak, R. Schilz, M. J. Rosen, A. Ignagni, A. Faulx, M. J. Elmo, S. SchomischAbstract:Background Up to 50% of the patients in the intensive care unit (ICU) require mechanical ventilation, with 20% requiring the use of a ventilator for more than 7 days. More than 40% of this time is spent weaning the patient from mechanical ventilation. Failure to wean from mechanical ventilation can in part be attributable to rapid onset of Diaphragm atrophy, barotrauma, posterior lobe atelectasis, and impaired hemodynamics, which are normally improved by maintaining a more natural negative chest pressure. The authors have previously shown that laparoscopic implantation of a Diaphragm Pacing system benefits selected patients. They now propose that an acute ventilator assist with interventional neurostimulation of the Diaphragm in the ICU is feasible and could facilitate the weaning of ICU patients from mechanical ventilation. Natural orifice transluminal endoscopic surgery (NOTES) has the potential to expand the benefits of the Diaphragm Pacing system to this acute patient population by allowing it to be performed at the bedside similarly to insertion of the common gastrostomy tube. This study evaluates the feasibility of this approach in a porcine model. Methods Pigs were anesthetized, and peritoneal access with the flexible endoscope was obtained using a guidewire, needle knife cautery, and balloon dilation. The Diaphragm was mapped using a novel endoscopic electrostimulation catheter to locate the motor point (where stimulation provides complete contraction of the Diaphragm). An intramuscular electrode then was placed at the motor point with a percutaneous needle. The gastrotomy was managed with a gastrostomy tube. Results Four pigs were studied, and the endoscopic mapping instrument was able to map the Diaphragm to identify the motor point. In one animal, a percutaneous electrode was placed into the motor point under transgastric endoscopic visualization, and the Diaphragm could be paced in conjunction with mechanical ventilation. Conclusions These animal studies demonstrate the feasibility of transgastric mapping of the Diaphragm and implantation of a percutaneous electrode for therapeutic Diaphragmatic stimulation.
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Diaphragm Pacing with natural orifice transluminal endoscopic surgery potential for difficult to wean intensive care unit patients
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: R. Onders, M. F. Mcgee, A. Chak, M. J. Rosen, A. Ignagni, A. Faulx, Maryjo Elmo, Robert Schilz, Jeffrey M Marks, S. SchomischAbstract:Background Up to 50% of the patients in the intensive care unit (ICU) require mechanical ventilation, with 20% requiring the use of a ventilator for more than 7 days. More than 40% of this time is spent weaning the patient from mechanical ventilation. Failure to wean from mechanical ventilation can in part be attributable to rapid onset of Diaphragm atrophy, barotrauma, posterior lobe atelectasis, and impaired hemodynamics, which are normally improved by maintaining a more natural negative chest pressure. The authors have previously shown that laparoscopic implantation of a Diaphragm Pacing system benefits selected patients. They now propose that an acute ventilator assist with interventional neurostimulation of the Diaphragm in the ICU is feasible and could facilitate the weaning of ICU patients from mechanical ventilation. Natural orifice transluminal endoscopic surgery (NOTES) has the potential to expand the benefits of the Diaphragm Pacing system to this acute patient population by allowing it to be performed at the bedside similarly to insertion of the common gastrostomy tube. This study evaluates the feasibility of this approach in a porcine model.
Maryjo Elmo - One of the best experts on this subject based on the ideXlab platform.
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Long-term experience with Diaphragm Pacing for traumatic spinal cord injury: Early implantation should be considered.
Surgery, 2018Co-Authors: R. Onders, Maryjo Elmo, Cindy Kaplan, Robert Schilz, Bashar Katirji, Glen TinkoffAbstract:Background Cervical spinal cord injury can result in catastrophic respiratory failure requiring mechanical ventilation with high morbidity, mortality, and cost. Diaphragm Pacing was developed to replace/decrease mechanical ventilation. We report the largest long-term results in traumatic cervical spinal cord injury. Methods In this retrospective review of prospective institutional review board protocols, all patients underwent laparoscopic Diaphragm mapping and implantation of electrodes for Diaphragm strengthening and ventilator weaning. Results From 2000 to 2017, 92 patients out of 486 Diaphragm Pacing implants met the criteria. The age at time of injury ranged from birth to 74 years (average: 27 years). Time on mechanical ventilation was an average of 47.5 months (range, 6 days to 25 years, median = 1.58 years). Eighty-eight percent of patients achieved the minimum of 4 hours of Pacing. Fifty-six patients (60.8%) used Diaphragm Pacing 24 hours a day. Five patients had full recovery of breathing with subsequent Diaphragm Pacing removal. Median survival was 22.2 years (95% confidence interval: 14.0–not reached) with only 31 deaths. Subgroup analysis revealed that earlier Diaphragm Pacing implantation leads to greater 24-hour use of Diaphragm Pacing and no need for any mechanical ventilation. Conclusion Diaphragm Pacing can successfully decrease the need for mechanical ventilation in traumatic cervical spinal cord injury. Earlier implantation should be considered.
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Final analysis of the pilot trial of Diaphragm Pacing in amyotrophic lateral sclerosis with long-term follow-up: Diaphragm Pacing positively affects Diaphragm respiration.
American journal of surgery, 2013Co-Authors: R. Onders, Maryjo Elmo, Cindy Kaplan, Bashar Katirji, Robert SchilzAbstract:Abstract Background Respiratory insufficiency is the major cause of mortality in patients with amyotrophic lateral sclerosis or Lou Gehrig’s disease. This is the final report of the Diaphragm Pacing (DP) pilot trial. Methods Patients underwent laparoscopic Diaphragm electrode implantations and subsequent conditioning of Diaphragms. Serial respiratory function tests were performed in the initial year and followed until death. Results Sixteen patients were implanted with no perioperative or unanticipated device-related adverse events. There were 452 implant-months of follow-up. DP allowed greater movement of the Diaphragm under fluoroscopy, increased muscle thickness, and decreased the decline in forced vital capacity. Median survival from implant was 19.7 months with the cause of death respiratory in only 31%. Conclusions Long-term analysis of DP in amyotrophic lateral sclerosis showed no safety issues and can positively influence Diaphragm physiology and survival. This formed the initial basis for subsequent US Food and Drug Administration approval.
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first reported experience with intramuscular Diaphragm Pacing in replacing positive pressure mechanical ventilators in children
Journal of Pediatric Surgery, 2011Co-Authors: R. Onders, Maryjo Elmo, Todd A Ponsky, Karen Lidsky, Edward M BarksdaleAbstract:Abstract Purpose Diaphragm Pacing (DP) has been shown to successfully replace mechanical ventilators for adult tetraplegic patients with chronic respiratory insufficiency. This is the first report of DP in ventilator-dependent children. Methods This was a prospective interventional experience under institutional review board approval. Diaphragm Pacing involves outpatient laparoscopic Diaphragm motor point mapping to identify the site where stimulation causes maximum Diaphragm contraction with implantation of 4 percutaneous intramuscular electrodes. Diaphragm conditioning ensues to wean the child from the ventilator. Results Six children were successfully implanted ranging from 5 to 17 years old with the smallest 15 kg in weight. Length of time on mechanical ventilation ranged from 11 days to 7.6 years with an average of 3.2 years. In all patients, DP provided tidal volumes above basal needs. Five of the patients underwent a home-based weaning program, whereas one patient who was implanted only 11 days post spinal cord injury never returned to the ventilator with DP use. Another patient was weaned from the ventilator full time but died of complications of his underlying brain stem tumor. The remaining patients weaned from the ventilator for over 14 hours a day and/or are actively conditioning their Diaphragms. Conclusion Diaphragm Pacing successfully replaced mechanical ventilators, which improves quality of life.
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complete worldwide operative experience in laparoscopic Diaphragm Pacing results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: R. Onders, Saeid Khansarinia, Maryjo Elmo, Brock Bowman, Jeremy Road, Barbara L Bass, Brian J Dunkin, Pall Ingvarsson, Margret OddsdottirAbstract:Background Diaphragm movement is essential for adequate ventilation, and when the Diaphragm is adversely affected patients face lifelong positive-pressure mechanical ventilation or death. This report summarizes the complete worldwide multicenter experience with Diaphragm Pacing stimulation (DPS) to maintain and provide Diaphragm function in ventilator-dependent spinal cord injury (SCI) patients and respiratory-compromised patients with amyotrophic lateral sclerosis (ALS). It will highlight the surgical experiences and the differences in Diaphragm function in these two groups of patients.
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Diaphragm Pacing with natural orifice transluminal endoscopic surgery potential for difficult to wean intensive care unit patients
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: R. Onders, M. F. Mcgee, A. Chak, M. J. Rosen, A. Ignagni, A. Faulx, Maryjo Elmo, Robert Schilz, Jeffrey M Marks, S. SchomischAbstract:Background Up to 50% of the patients in the intensive care unit (ICU) require mechanical ventilation, with 20% requiring the use of a ventilator for more than 7 days. More than 40% of this time is spent weaning the patient from mechanical ventilation. Failure to wean from mechanical ventilation can in part be attributable to rapid onset of Diaphragm atrophy, barotrauma, posterior lobe atelectasis, and impaired hemodynamics, which are normally improved by maintaining a more natural negative chest pressure. The authors have previously shown that laparoscopic implantation of a Diaphragm Pacing system benefits selected patients. They now propose that an acute ventilator assist with interventional neurostimulation of the Diaphragm in the ICU is feasible and could facilitate the weaning of ICU patients from mechanical ventilation. Natural orifice transluminal endoscopic surgery (NOTES) has the potential to expand the benefits of the Diaphragm Pacing system to this acute patient population by allowing it to be performed at the bedside similarly to insertion of the common gastrostomy tube. This study evaluates the feasibility of this approach in a porcine model.
Robert Schilz - One of the best experts on this subject based on the ideXlab platform.
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Long-term experience with Diaphragm Pacing for traumatic spinal cord injury: Early implantation should be considered.
Surgery, 2018Co-Authors: R. Onders, Maryjo Elmo, Cindy Kaplan, Robert Schilz, Bashar Katirji, Glen TinkoffAbstract:Background Cervical spinal cord injury can result in catastrophic respiratory failure requiring mechanical ventilation with high morbidity, mortality, and cost. Diaphragm Pacing was developed to replace/decrease mechanical ventilation. We report the largest long-term results in traumatic cervical spinal cord injury. Methods In this retrospective review of prospective institutional review board protocols, all patients underwent laparoscopic Diaphragm mapping and implantation of electrodes for Diaphragm strengthening and ventilator weaning. Results From 2000 to 2017, 92 patients out of 486 Diaphragm Pacing implants met the criteria. The age at time of injury ranged from birth to 74 years (average: 27 years). Time on mechanical ventilation was an average of 47.5 months (range, 6 days to 25 years, median = 1.58 years). Eighty-eight percent of patients achieved the minimum of 4 hours of Pacing. Fifty-six patients (60.8%) used Diaphragm Pacing 24 hours a day. Five patients had full recovery of breathing with subsequent Diaphragm Pacing removal. Median survival was 22.2 years (95% confidence interval: 14.0–not reached) with only 31 deaths. Subgroup analysis revealed that earlier Diaphragm Pacing implantation leads to greater 24-hour use of Diaphragm Pacing and no need for any mechanical ventilation. Conclusion Diaphragm Pacing can successfully decrease the need for mechanical ventilation in traumatic cervical spinal cord injury. Earlier implantation should be considered.
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Final analysis of the pilot trial of Diaphragm Pacing in amyotrophic lateral sclerosis with long-term follow-up: Diaphragm Pacing positively affects Diaphragm respiration.
American journal of surgery, 2013Co-Authors: R. Onders, Maryjo Elmo, Cindy Kaplan, Bashar Katirji, Robert SchilzAbstract:Abstract Background Respiratory insufficiency is the major cause of mortality in patients with amyotrophic lateral sclerosis or Lou Gehrig’s disease. This is the final report of the Diaphragm Pacing (DP) pilot trial. Methods Patients underwent laparoscopic Diaphragm electrode implantations and subsequent conditioning of Diaphragms. Serial respiratory function tests were performed in the initial year and followed until death. Results Sixteen patients were implanted with no perioperative or unanticipated device-related adverse events. There were 452 implant-months of follow-up. DP allowed greater movement of the Diaphragm under fluoroscopy, increased muscle thickness, and decreased the decline in forced vital capacity. Median survival from implant was 19.7 months with the cause of death respiratory in only 31%. Conclusions Long-term analysis of DP in amyotrophic lateral sclerosis showed no safety issues and can positively influence Diaphragm physiology and survival. This formed the initial basis for subsequent US Food and Drug Administration approval.
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Diaphragm Pacing with natural orifice transluminal endoscopic surgery potential for difficult to wean intensive care unit patients
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: R. Onders, M. F. Mcgee, A. Chak, M. J. Rosen, A. Ignagni, A. Faulx, Maryjo Elmo, Robert Schilz, Jeffrey M Marks, S. SchomischAbstract:Background Up to 50% of the patients in the intensive care unit (ICU) require mechanical ventilation, with 20% requiring the use of a ventilator for more than 7 days. More than 40% of this time is spent weaning the patient from mechanical ventilation. Failure to wean from mechanical ventilation can in part be attributable to rapid onset of Diaphragm atrophy, barotrauma, posterior lobe atelectasis, and impaired hemodynamics, which are normally improved by maintaining a more natural negative chest pressure. The authors have previously shown that laparoscopic implantation of a Diaphragm Pacing system benefits selected patients. They now propose that an acute ventilator assist with interventional neurostimulation of the Diaphragm in the ICU is feasible and could facilitate the weaning of ICU patients from mechanical ventilation. Natural orifice transluminal endoscopic surgery (NOTES) has the potential to expand the benefits of the Diaphragm Pacing system to this acute patient population by allowing it to be performed at the bedside similarly to insertion of the common gastrostomy tube. This study evaluates the feasibility of this approach in a porcine model.
Thomas Similowski - One of the best experts on this subject based on the ideXlab platform.
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Corrective effect of Diaphragm Pacing on the decrease in cardiac output induced by positive pressure mechanical ventilation in anesthetized sheep
Respiratory physiology & neurobiology, 2016Co-Authors: Hicham Masmoudi, Alexandre Demoule, Romain Persichini, Jérôme Cecchini, Julie Delemazure, Martin Dres, Julien Mayaux, Jalal Assouad, Thomas SimilowskiAbstract:Abstract Positive pressure ventilation (PPV) is a fundamental life support measure, but it decreases cardiac output (CO). Diaphragmatic contractions produce negative intrathoracic and positive abdominal pressures, promoting splanchnic venous return. We hypothesized that: 1) Diaphragm Pacing alone could produce adequate ventilation without decreasing CO; 2) Diaphragm Pacing on top of PPV could improve CO. Of 11 anesthetized and mechanically ventilated ewes (39.6 ± 5.9 kg), 3 were discarded from analysis because of hemodynamic instability during the experiment, and 8 retained for analysis. Phrenic stimulation electrodes were inserted in the Diaphragm (implanted phrenic nerve stimulation, iPS). CO was measured by the thermodilution technique (pulmonary artery catheter). CO during end-expiratory apnea served as reference. Median CO was 9.77 [6.25–11.25] l min−1 during end-expiratory apnea, 8.25 [5.06–9.25] l min−1 during “PPV” (−15%) (p
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referred shoulder pain c4 dermatome can adversely impact Diaphragm Pacing with intramuscular electrodes
European Respiratory Journal, 2015Co-Authors: Thomas Similowski, Capucine Morelotpanzini, Francoise Le Pimpecbarthes, Fabrice Menegaux, Jesus GonzalezbermejoAbstract:Diaphragm Pacing with intramuscular electrodes causes pain in central hypoventilation patients without spinal lesions http://ow.ly/IItjY
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Diaphragm Pacing failure secondary to deteriorated chest wall mechanics: When a good Diaphragm does not suffice to take a good breath in
Respiratory Medicine Case Reports, 2015Co-Authors: Lila Layachi, Jésus Gonzalez-bermejo, Marjolaine Georges, Thomas Similowski, Anne-laure Brun, Capucine Morélot-panziniAbstract:Diaphragm Pacing allows certain quadriplegic patients to be weaned from mechanical ventilation. Pacing failure can result from device dysfunction, neurotransmission failure, or degraded lung mechanics (such as atelectasis). We report two cases where progressive Pacing failure was attributed to deteriorated chest wall mechanics. The first patient suffered from cervical spinal cord injury at age 45, was implanted with a phrenic stimulator (intrathoracic), successfully weaned from ventilation, and permanently paced for 7 years. Pacing effectiveness then slowly declined, finally attributed to rib cage stiffening due to ankylosing spondylitis. The second patient became quadriplegic after meningitis at age 15, was implanted with a phrenic stimulator (intraDiaphragmatic) and weaned. After a year hypoventilation developed without obvious cause. In relationship with complex endocrine disorders, the patient had gained 31 kg. Pacing failure was attributed to excessive mechanical inspiratory load. Rib cage mechanics abnormalities should be listed among causes of Diaphragm Pacing failure and it should be kept in mind that a “good Diaphragm” is not sufficient to produce a “good inspiration”.
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Can Diaphragm Pacing improve gas exchange? Insights from quadriplegic patients
The European respiratory journal, 2013Co-Authors: Jésus Gonzalez-bermejo, Capucine Morélot-panzini, Marjolaine Georges, Alexandre Demoule, Thomas SimilowskiAbstract:To the Editor: Diaphragm Pacing, as obtained by phrenic nerve stimulation through implanted electrodes, is a valid alternative to positive pressure mechanical ventilation (PPV) in patients with high spinal cord injuries [1]. Diaphragm Pacing allows such patients to be weaned from PPV, but, to date, the respective effects of Diaphragm Pacing and PPV on gas exchange have not been compared. PPV is known to reduce ventilation in the lung bases [2]. By contrast, Diaphragm Pacing, like spontaneous breathing, should direct a larger proportion of the inspired volume to the lung bases. This should improve ventilation/perfusion matching. If this is the case, Diaphragm Pacing could be of interest as an adjunct to PPV in patients with lung injury. Indeed, in this setting, preserving Diaphragmatic activity during mechanical ventilation can improve arterial oxygenation [3]. However, this can be difficult to achieve from a comfort point of view. In a proof-of-concept perspective, we compared blood gases and energy expenditure during PPV and Diaphragm Pacing in 10 quadriplegics. 10 consecutive, stable and well-nourished tracheotomised quadriplegic patients were studied (six males, aged 15–46 years, mean±sd body mass index 21.9±4.0 kg·m−2). All had a phrenic nerve stimulator (Atrostim; Atrotech, Tampere, Finland) implanted at least 6 months earlier and were considered fully reconditioned. They were studied during planned routine visits, after approval of the ethics committee of the French Learned Society for Intensive Care Medicine. All patients gave their informed consent. Measurements were performed at least 3 h after a meal, with the tracheal cuff inflated. Oxygen consumption ( V ′O2), carbon dioxide production ( V ′CO2) and respiratory quotient were …
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Reversal of pulmonary hypertension after Diaphragm Pacing in an adult patient with congenital central hypoventilation syndrome.
The International journal of artificial organs, 2013Co-Authors: Capucine Morélot-panzini, Jésus Gonzalez-bermejo, Christian Straus, Thomas SimilowskiAbstract:IntroductionPatients with the congenital central hypoventilation syndrome (CCHS) suffer from life-threatening hypoventilation when asleep, making them dependent on mechanical ventilation (MV) at night or during naps. State-of-art respiratory management consists of intermittent positive-pressure ventilation via a tracheotomy or mask. In some patients hypoventilation is permanent, in which case ventilatory support must be extended to the waking hours. Diaphragm Pacing can prove useful in such situations.Methods and ResultsThis report describes the case of a 26-year-old woman with CCHS in whom failure to achieve adequate MV led to life-threatening pulmonary hypertension (PH), with a systolic pulmonary artery pressure (PAP) of 80 mmHg and right ventricular hypertrophy, despite optimization of all possible measures and despite extensive therapeutic education efforts. Diaphragm Pacing using laparoscopically implanted intraDiaphragmatic phrenic nerve stimulation electrodes corrected alveolar hypoventilation and ...