Phrenic pacing compared with mechanical ventilation

Abstract

STUDY DESIGN: Comparable case series. OBJECTIVES: High-cervical spinal cord injury (SCI) may disrupt the ability to breathe sufficiently. To restore respiration a phrenic nerve pacer can be implanted. The aims of this study were to describe the use of phrenic nerve pacing in tetraplegics in Denmark and compare the users with a population of ventilator dependent tetraplegics. SETTING: Clinics for Spinal Cord Injuries, and Respiratory Centre East, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. METHODS: Nine tetraplegic individuals who had implantation of a phrenic nerve pacer and 16 home mechanical ventilator dependent tetraplegics met the inclusion criteria. Data were retrieved from medical records and a structured follow-up interview with seven individuals from each group. RESULTS: No significant differences were found when comparing age at injury, time since injury, length of hospitalization, incidence of pneumonia, number of pneumonia hospitalizations, number of tracheal suctions, speech quality and activities of daily living or quality of life. On the Short Form Health Survey (SF36) mental health summary the median for both users of phrenic nerve pacing and users of mechanical ventilation was one s.d. above the mean of a standard population. CONCLUSIONS: Nine people have had a phrenic nerve pacer implanted. They do not significantly differ from a group of home mechanical ventilator dependent tetraplegics on a number of performance measures, but both groups seem to have better quality of life than a standard population. (2017) Spinal Cord Series and Cases INTRODUCTIONSpinal cord injury (SCI) is one of the most devastating injuries a person can be the victim of. It renders the body sense-and motionless and incapacitates the autonomic nervous system including the loss of bladder, bowel and sexual function. The primary respiratory muscle is the diaphragm innervated by the phrenic nerve arising primarily from the C4 segment of the spinal cord. Any damage at or above C4 has the potential for destroying the link between the respiratory centers of the brain and the diaphragm. Thus, in the case of high-cervical SCI resulting in tetraplegia even the ability to breathe sufficiently may be disrupted.By applying an electrical current to the phrenic nerve, it is possible to make the diaphragm contract, and thus create an inspiration. This has been known for centuries, 1 but the technology for making phrenic nerve pacing a viable alternative to mechanical positive pressure ventilation is only four decades old.2 Reports of long-time use in tetraplegic patients came in 1976.

Mental health reported in adult invasive home mechanical ventilation through a tracheostomy: A scoping review

“…All included studies were assessed to give a positive response to the two screening questions in the Mixed Methods Appraisal Tool. The methodological quality was assessed to be high in nine studies (Dreyer et al, 2010b;Briscoe and Woodgate, 2010;Huttmann et al, 2015;Jacobs et al, 2021;Jacobs et al, 2020;Klingshirn et al, 2022;Nelissen et al, 2019;Valko et al, 2020;Yamaguchi and Suzuki, 2013) and medium in four studies (Andersen et al, 2017;Dale et al, 2018;Dyrstad et al, 2013;Rousseau et al, 2011) (Table 3).…”

“…The included studies are summarised in Table 3. Of the 13 studies included, 10 were authored in Europe (Andersen et al, 2017;Dreyer et al, 2010b;Dyrstad et al, 2013;Huttmann et al, 2015;Jacobs et al, 2021;Jacobs et al, 2020;Klingshirn et al, 2022;Nelissen et al, 2019;Rousseau et al, 2011;Valko et al, 2020). Outside Europe, two studies were authored in the Americas (Briscoe and Woodgate, 2010;Dale et al, 2018) and one in the Western Pacific (Yamaguchi and Suzuki, 2013).…”

“…Outside Europe, two studies were authored in the Americas (Briscoe and Woodgate, 2010;Dale et al, 2018) and one in the Western Pacific (Yamaguchi and Suzuki, 2013). Eleven out of the 13 studies included people receiving tracheostomy ventilation in their own homes (Andersen et al, 2017;Dreyer et al, 2010b;Briscoe and Woodgate, 2010;Dale et al, 2018;Dyrstad et al, 2013;Huttmann et al, 2015;Jacobs et al, 2020;Klingshirn et al, 2022;Nelissen et al, 2019;Valko et al, 2020;Yamaguchi and Suzuki, 2013). Of these, seven studies included additional people living in home settings other than private homes (e.g., in long-term care) (Dreyer et al, 2010b;Briscoe and Woodgate, 2010;Dyrstad et al, 2013;Huttmann et al, 2015;Jacobs et al, 2020;Klingshirn et al, 2022;Nelissen et al, 2019).…”

“…Seven studies were published in medical journals (Andersen et al, 2017;Dale et al, 2018;Huttmann et al, 2015;Jacobs et al, 2021;Jacobs et al, 2020;Rousseau et al, 2011;Valko et al, 2020), three in public health journals (Dreyer et al, 2010b;Briscoe and Woodgate, 2010;Yamaguchi and Suzuki, 2013), and three in nursing journals (Dyrstad et al, 2013;Klingshirn et al, 2022;Nelissen et al, 2019)). Within the investigation time span , an average of one study per year was published, although no studies were published for three of the years (2012, 2014 and 2016).…”

“…Within the investigation time span , an average of one study per year was published, although no studies were published for three of the years (2012, 2014 and 2016). More than half of the studies (n = 7; 53.9%) were published from 2017 to 2022 (Andersen et al, 2017;Dale et al, 2018;Jacobs et al, 2021;Jacobs et al, 2020;Klingshirn et al, 2022;Nelissen et al, 2019;Valko et al, 2020).…”