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Multicenter Study
. 2022;101(1):18-24.
doi: 10.1159/000517401. Epub 2021 Jul 16.

Diaphragm Pacing in Patients with Spinal Cord Injury: A European Experience

Peter J Wijkstra  1 , Hans van der Aa  1 , H Sijbrand Hofker  2 , Francesco Curto  3 , Matteo Giacomini  3 , Giuliana Stagni  3 , Maria Asuncion Dura Agullo  4 , Francesc Xavier Curià Casanoves  5   6   7 , Jesús Benito-Penalva  5   6   7 , Carlos Martinez-Barenys  5   6   8 , Joan Vidal  5   6   7
Affiliations
Multicenter Study

Diaphragm Pacing in Patients with Spinal Cord Injury: A European Experience

Peter J Wijkstra et al. Respiration. 2022.

Abstract

Background: Patients with high spinal cord injury (SCI) are unable to breathe on their own and require mechanical ventilation (MV). The long-term use of MV is associated with increased morbidity and mortality. In patients with intact phrenic nerve function, patients can be partially or completely removed from MV by directly stimulating the diaphragm motor points with a diaphragm pacing system (DPS).

Objectives: We describe our multicenter European experience using DPS in SCI patients who required MV.

Methods: We conducted a retrospective study of patients who were evaluated for the implantation of DPS. Patients evaluated for DPS who met the prospectively defined criteria of being at least 1 year of age, and having cervical injury resulting in a complete or partial dependency on MV were included. Patients who received DPS implants were followed for up to 1 year for device usage and safety.

Results: Across 3 centers, 47 patients with high SCI were evaluated for DPS, and 34 were implanted. Twenty-one patients had 12 months of follow-up data with a median DPS use of 15 h/day (interquartile range 4, 24). Eight patients (38.1%) achieved complete MV weaning using DPS 24 h/day. Two DPS-related complications were surgical device revision and a wire eruption. No other major complications were associated with DPS use.

Conclusions: Diaphragm pacing represents an attractive alternative stand-alone treatment or adjunctive therapy compared to MV in patients with high SCI. After a period of acclimation, the patients were able to reduce the daily use of MV, and many could be completely removed from MV.

Keywords: Diaphragm pacing; Mechanical ventilation; Spinal cord injury; Weaning.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Patient flow consort diagram. DPS, diaphragm pacing system.
See this image and copyright information in PMC

References

    1. Lee BB, Cripps RA, Fitzharris M, Wing PC. The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord. 2014;52((2)):110–6. - PubMed
    1. Mitchell RA, Berger AJ. Neural regulation of respiration. Am Rev Respir Dis. 1975 Feb;111((2)):206–24. - PubMed
    1. Gonzalez-Bermejo J, LLontop C, Similowski T, Morélot-Panzini C. Respiratory neuromodulation in patients with neurological pathologies: for whom and how? Ann Phys Rehabil Med. 2015;58((4)):238–44. - PubMed
    1. Onders RP, Elmo M, Kaplan C, Schilz R, Katirji B, Tinkoff G. Long-term experience with diaphragm pacing for traumatic spinal cord injury: early implantation should be considered. Surgery. 2018;164((4)):705–11. - PubMed
    1. Resman-Gaspersc A, Podnar S. Phrenic nerve conduction studies: technical aspects and normative data. Muscle Nerve. 2008;37((1)):36–41. - PubMed

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