Document Detail


Long-term follow-up of pacing of the conditioned diaphragm in quadriplegia.
MedLine Citation:
PMID:  12137341     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The authors have previously shown that conditioning of the diaphragm for continuous bilateral pacing is a feasible and effective means of ventilation in patients with complete respiratory paralysis from high cervical (above C3) quadriplegia. The present study reports the long-term results of continuous diaphragmatic pacing. Twelve quadriplegia patients underwent bilateral phrenic nerve pacemaker placement and diaphragm conditioning from 1981 to 1987. Pacing was initiated at 11 Hz and progressively decreased to 7.1 Hz. A pulse train duration of 1.3 seconds for adults and 0.9 seconds for children was used. Long-term follow-up information obtained included pacing status (full-time, part-time, or mechanical ventilation), ventilation parameters, and social circumstances. Of the 12 patients, 6 continued to pace full time (mean 14.8 years); all were living at home. Three patients paced for an average of 1.8 years before stopping; two were institutionalized. One patient who paced full time for 6.5 years before lapsing to part time, lived at home. Two patients were deceased; one paced continuously for 10 years before his demise, the other stopped pacing after 1 year. Patients who stopped full-time pacing did so mainly for reasons of inadequate social or financial support or associated medical problems. All patients demonstrated normal tidal volumes and arterial blood gases while pacing full time. Despite theoretical concerns about long-term nerve damage, no patient lost the ability to pace the phrenic nerve. Threshold currents did not increase over time (original/follow-up: 0.46/0.47 for right, 0.45/0.46 for left), nor did maximal currents (original/follow-up: 1.16/1.14 for right, 1.37/1.26 for left). This follow-up confirms that quadriplegic patients are able to meet long-term, full-time ventilation requirements using phrenic nerve stimulation of the conditioned diaphragm. Careful review of diaphragmatic pacing candidates with respect to associated medical conditions, social support, and motivation is essential for appropriate patient selection and successful long-term results.
Authors:
John A Elefteriades; Jacquelyn A Quin; James F Hogan; Wade G Holcomb; George V Letsou; William F Chlosta; William W W L Glenn
Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  25     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-07-24     Completed Date:  2003-02-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  897-906     Citation Subset:  IM    
Affiliation:
Sections of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA. john.elefteriades@yale.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Diaphragm* / innervation
Electric Stimulation Therapy*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Phrenic Nerve
Quadriplegia / complications*
Respiratory Paralysis / etiology,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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