Radio-Frequency Electrophrenic Respiration

Judson, John Paul; Glenn, William W. L.

doi:10.1001/jama.1968.03140120031007

Cited by 77 publications

(16 citation statements)

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“…1,2 However, electroventilation 3 has become a choice again through its modern versions such as diaphragm pacing (DP), 4,5 carousel stimulation (CS) 6 and four-pole-sequential phrenic nerve stimulation (PNS). 7 In electroventilation, an electrical system rhythmically stimulating the phrenic nerves takes over for the malfunctioning or inaccessible respiratory centre; a normal phrenic nerve and normal diaphragm muscle are prerequisites.…”

Section: Introductionmentioning

confidence: 99%

“…7 In electroventilation, an electrical system rhythmically stimulating the phrenic nerves takes over for the malfunctioning or inaccessible respiratory centre; a normal phrenic nerve and normal diaphragm muscle are prerequisites. 8 The reason to develop the Diaphragm Pacer 4 and similar devices 6,7 was to 'free the patient from the mechanical ventilator'. 4 By using the mechanical energy of the patient's diaphragm, the patient is freed from the ventilator tube, the tracheostoma and with his helpers from the bulky energy supply of mechanical ventilators (MVs).…”

Section: Introductionmentioning

confidence: 99%

“…8 The reason to develop the Diaphragm Pacer 4 and similar devices 6,7 was to 'free the patient from the mechanical ventilator'. 4 By using the mechanical energy of the patient's diaphragm, the patient is freed from the ventilator tube, the tracheostoma and with his helpers from the bulky energy supply of mechanical ventilators (MVs). However, when deciding on which device to use, more weight was frequently put on the higher price for the device, the surgical risk of implantation, improvement of MVs and absence of indications than was put on freedom from MV, the improved quality of speech and nursing facilitation.…”

Section: Introductionmentioning

confidence: 99%

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Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

et al. 2008

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Study design: Prospective clinical study of two treatments. Objective: To compare mechanical ventilation (MV) with phrenic nerve stimulation (PNS) for treatment of respiratory device-dependent (RDD) spinal cord-injured (SCI) patients. Setting: Department for spinal cord-injured patients of an insurance-company-run trauma hospital in Hamburg, Germany. Methods: Prospective data collection of treatment-related data over 20 years. Results: In total, 64 SCI-RDD patients were treated during the study period. Of these, 32 of the patients with functioning phrenic nerves and diaphragm muscles were treated with PNS and 32 patients with destroyed phrenic nerves were mechanically ventilated. Incidence of respiratory infections (RIs per 100 days) prior to use of final respiratory device was equal in both groups, that is (median (interquartile range)) 1.43 (0.05-3.92) with PNS and 1.33 (0.89-2.21) with MV (P ¼ 0.888); with final device in our institution it was 0 (0-0.92) with PNS and 2.07 (1.49-4.19) with MV (Po0.001); at final location it was 0 (0-0.02) with PNS and 0.14 (0-0.31) with MV (Po0.001). Thus, compared to MV, respiratory treatment with PNS significantly reduces frequency of RI. Quality of speech is significantly better with PNS. Nine patients with PNS, but only two with MV, were employed or learned after rehabilitation (P ¼ 0.093). The primary investment in the respiratory device is higher with PNS, but it can be paid off in our setting within 1 year because of the reduced amount of single use equipment, easier nursing and fewer RIs compared to MV. Conclusions: PNS instead of MV for treatment of SCI-RDD reduces RIs, running costs of respiratory treatment and obviously improves patients' quality of life.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

et al. 2008

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“…

The clinical application of diaphragmatic pacing by phrenic nerve stimulation started about 40 years ago with the pioneer works of Glenn and coworkers [1][2][3]. They introduced a radiofrequency pacemaker system and made diaphragm pacing a practical method of supporting ventilation in patients with chronic ventilatory failure.

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confidence: 99%

Problems Associated with Diaphragm Pacing

Nishino¹

2002

Respiration

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“…However, this technique could not provide extended support because of the risk of infection inherent with percutaneous wires. Prolonged ventilatory support by phrenic nerve stimulation (diaphragm pacing) was first accomplished successfully in 1966 by Judson and Glenn [4], who developed an implantable radiofrequency phrenic pacemaker activated and powered by an external transmitter.…”

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confidence: 99%

Diaphragm Pacing for Ventilatory Insufficiency

Marcy

Loke

1987

J Intensive Care Med

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Prolonged ventilatory support by phrenic nerve stimulation (diaphragm pacing) has been developed into a useful therapeutic technique over the past two decades. The benefits of diaphragm pacing to patients with respiratory insufficiency resulting from central alveolar hypoventilation, and respiratory paralysis associated with quadriplegia, have led physicians to consider diaphragm pacing in patients with respiratory insufficiency who are dependent on ventilatory support. Some of these patients are initially seen in the intensive care unit because of respiratory failure or arrest. We discuss the evaluation and selection of candidates for diaphragm pacing. For over 200 years physicians have attempted to ventilate patients artificially by electrically stimulating the phrenic nerves [1]. In 1950 Sarnoff and colleagues [2,3] ventilated patients with acute respiratory insufficiency resulting from bulbar poliomyelitis by stimulating the phrenic nerves with electrodes connected to percutaneous wires. However, this technique could not provide extended support because of the risk of infection inherent with percutaneous wires. Prolonged ventilatory support by phrenic nerve stimulation (diaphragm pacing) was first accomplished successfully in 1966 by Judson and Glenn [4], who developed an implantable radiofrequency phrenic pacemaker activated and powered by an external transmitter.In the past 20 years about 600 patients have been treated with diaphragm pacing for chronic ventilatory insufficiency [5]. The technique requires intrathoracic implantation of electrodes on the phrenic nerve. Although the electrode can be implanted on the phrenic nerve through a cervical incision, this is not the preferred approach because the electrode will not stimulate branches of the phrenic nerve that join the main trunk in the thorax [5].The electrodes are connected to a subcutaneously implanted radiofrequency receiver. An external radiofrequency transmitter provides power to the receiver, generating a series of direct current pulses to the phrenic nerve. Respiratory rate and the amplitude of diaphragm contraction are controlled by adjusting the external transmitter (Figure). Refinements of the technique have decreased the incidence of phrenic nerve damage during operations, and have reduced the problem of diaphragm fatigue [5,6]. In many patients with respiratory paralysis from quadriplegia, bilateral diaphragm pacing [6] has eliminated or reduced the need for mechanical ventilation from a positivepressure ventilator, allowing these patients greater mobility and independence [6][7][8][9][10][11]. Unilateral diaphragm pacing has been used for patients with central alveolar hypoventilation (CAH) [10]; however,

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Radio-Frequency Electrophrenic Respiration

Cited by 77 publications

References 6 publications

Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

Problems Associated with Diaphragm Pacing

Diaphragm Pacing for Ventilatory Insufficiency

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