Chest
Selected ReportsPhrenic Nerve Pacing Via Intramuscular Diaphragm Electrodes in Tetraplegic Subjects
Section snippets
Subjects
Five subjects with trauma-induced high cervical spinal cord injury who required long-term mechanical ventilatory support were studied. All subjects were in stable condition at the time of study (ie, free of significant lung, cardiovascular, or brain disease). Highly motivated subjects with sufficient caregiver support were recruited for this study. This investigation was approved by the US Food and Drug Administration (Investigational Device Exemption G920162) and also by the institutional
Results
Maximum changes in inspired volume resulting from separate left and right hemidiaphragm stimulation and bilateral stimulation, at various intervals during the reconditioning period, are superimposed for one subject in Figure 2. There were progressive increases in inspired volume generation during unilateral and bilateral diaphragm stimulation. Since the inspiratory time was constant at 1.1 s under all conditions, increases in inspired volume were achieved by increases in inspiratory flow rate.
Discussion
In a previous case report,15 we described the first tetraplegic subject in whom full-time diaphragm pacing could be maintained via IM diaphragm electrodes. In the current report, additional clinical experience with this technique and a modification of the method of electrode insertion has been presented. The results indicate that artificial ventilation via IM diaphragm pacing provides a similar degree of ventilatory support and clinical benefit to ventilator-dependent tetraplegic subjects when
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2023, Current Opinion in Biomedical EngineeringDiaphragm stimulation elicits phrenic afferent-induced neuromuscular plasticity
2023, Respiratory Physiology and NeurobiologyEffects of restoration of cough via spinal cord stimulation on subject quality of life
2022, Journal of Clinical Orthopaedics and TraumaEpidural electrical spinal cord stimulation of the thoracic segments (T2-T5) facilitates respiratory function in patients with complete spinal cord injury
2022, Respiratory Physiology and NeurobiologyCitation Excerpt :Based on these findings, we hypothesize that high frequency EES at the T2–5 region affects the neuro-muscular junction (NMJ), which works via N-acetylcholine receptors and may trigger some relevant changes, so the patients’ self-breathing pattern became negligible. This could be further confirmed with a biopsy of neuro-muscular junction and N-acetylcholine depletion as previously demonstrated it can cause breathing difficulties and lead to death (DiMarco et al., 2005b, 2002). In fact, in this study not only stimulus frequency was critical, but also the amplitude and pulse width had a major role on EES-enabled respiration.
Spinal cord injury and degenerative cervical myelopathy
2022, Handbook of Clinical Neurology
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).
This work was supported by US Food and Drug Administration grant FD-R-001839 and by the Rehabilitation Research Service of the Veterans Affairs.