Multicenter analysis of diaphragm pacing in tetraplegics with cardiac pacemakers: Positive implications for ventilator weaning in intensive care units

Phrenic Nerve Pacing: Current Concepts

“…It is estimated that a 15 year-old who sustains a high SCI and survives the first 24 hours, the need of mechanical ventilation decreases life expectancy by 21 years (7); in the case of a 40 year-old patient with tetraplegia and ventilator dependence who survives the Phrenic Nerve Pacing: Current Concepts 273 first 24 hours life expectancy is 7 years. It is dramatically reduced to 1.8 years in a 60 yearold with SCI (8,9).…”

“…More than 80% of injuries are traumatic in nature, and up to 1.5% of such injuries are sustained in children. Many of these patients cannot be eventually weaned off mechanical ventilation, and require chronic ventilator support in as much as 4% of the cases (4,6,7,8). In the United States more than 100,000 tracheostomies are performed for patients who are unable to be weaned from ventilator (8,9).…”

“…Many of these patients cannot be eventually weaned off mechanical ventilation, and require chronic ventilator support in as much as 4% of the cases (4,6,7,8). In the United States more than 100,000 tracheostomies are performed for patients who are unable to be weaned from ventilator (8,9). In most of these cases the lungs, chest wall, and respiratory muscles are usually physiologically normal (4).…”

“…Controlled mechanical ventilation leads to rapid atrophy of the diaphragm. Within 18 hours of mechanical ventilation there is a decrease in type I muscle fibers with conversion to less functional fast-twitch type IIb muscle fibers (8). Beyond one year the chances of recovery of fully independent breathing is probably less than 5% of patients with complete high tetraplegia (10).…”

“…Mechanical ventilation in tracheostomy patients has several complications such as speech difficulties, reduced mobility, difficulty with transfers, social limitations, loss of sense of smell, equipment malfunction, increased respiratory infections, and increased cost of care approaching $200,000 a year (7,8,10,11).…”