TY - JOUR
T1 - Diaphragm Pacing in Patients with Spinal Cord Injury
T2 - A European Experience
AU - Wijkstra, Peter J.
AU - van der Aa, Hans
AU - Hofker, H. Sijbrand
AU - Curto, Francesco
AU - Giacomini, Matteo
AU - Stagni, Giuliana
AU - Dura Agullo, Maria Asuncion
AU - Curia Casanoves, Francesc Xavier
AU - Benito-Penalva, Jesus
AU - Martinez-Barenys, Carlos
AU - Vidal, Joan
PY - 2022/1
Y1 - 2022/1
N2 - 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.
AB - 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.
KW - Spinal cord injury
KW - Diaphragm pacing
KW - Mechanical ventilation
KW - Weaning
KW - PHRENIC-NERVE CONDUCTION
KW - MECHANICAL VENTILATION
KW - STIMULATION
KW - SURVIVAL
U2 - 10.1159/000517401
DO - 10.1159/000517401
M3 - Article
SN - 0025-7931
VL - 101
SP - 18
EP - 24
JO - Respiration
JF - Respiration
IS - 1
ER -