Abstract
Background The aim of this study is to evaluate the outcomes of patients submitted to diaphragmatic pacing, and the impact on quality of life of patients who chronically depend on mechanical ventilation, as well as the effectiveness of phrenic stimulation to eliminate the need for mechanical ventilation. Methods From 2010- 2014, 10 patients completely dependent on mechanical ventilation were operated upon, with the implantation of phrenic pacing device. The diagnoses were quadriplegia and congenital central hypoventilation syndrome (CCHS). All patients underwent bilateral approach to the phrenic nerves, by video-assisted thoracic surgery or mini-thoracotomy. Results All patientsstarted pacing 30-40 days post-operatively. The mean age of patients was 12.1 years (2-27 years range) with a median of ten years. Six patients (54.5%) were as old as ten years, and three (27.2%) were older than 20 years. Younger patients had CCHS and older ones were quadriplegic. All patients with CCHS (n = 4) were nine years old or younger while only two quadriplegic patients were in this age group. Conclusions Diaphragmatic pacing can provide improvement in the quality of life of patients who depend on mechanical ventilation, allowing freedom to conduct daily activities, lower respiratory infections, and tracheostomy decannulation.
Highlights
Since the invention of the electric stimulators byOtto von Guericke in 1663, some doctors have tried using electricity in medical experiments that ranged from simple attempts to reverse paralysis to revive the patients
The first suggested stimulation of the phrenic nerve for cardiopulmonary resuscitation was proposed by Cavallo in 17771
The science of phrenic stimulation was studied in more detail by Duchenne during the cholera epidemic in 1827, Israel in 1927, and by Sarnoff in 1950 in polio victims 2
Summary
Since the invention of the electric stimulators by. Otto von Guericke in 1663, some doctors have tried using electricity in medical experiments that ranged from simple attempts to reverse paralysis to revive the patients. Only after the invention of electrical stimulation in animals by Galvani in 1787 and Ure in 1818, electricity was applied in a recently hanged patient and watched diaphragmatic contractions[1]. The science of phrenic stimulation was studied in more detail by Duchenne during the cholera epidemic in 1827, Israel in 1927, and by Sarnoff in 1950 in polio victims 2. Such reports remained crucial to allow for better understanding of phrenic stimulation in patients with diaphragmatic paralysis. The aim of this study is to evaluate the outcomes of patients submitted to diaphragmatic pacing, and the impact on quality of life of patients who chronically depend on mechanical ventilation, as well as the effectiveness of phrenic stimulation to eliminate the need for mechanical ventilation
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