Artificial respiration by phrenic nerve stimulation (diaphragm pacing) in patients with cervical cord and brain stem lesions

Abstract

In patients who are dependent upon respirators because of paralysis of respiratory muscles, pacemakers for electrical stimulation of the phrenic nerves, leading to contractions of the diaphragm, are available. We have implanted such diaphragm pacers in ten selected patients with partial or total respiratory insufficiency of central nervous origin. Preoperatively, transcutaneous phrenic nerve stimulation in the neck was undertaken with simultaneous fluoroscopy of the diaphragm and quantitative studies of ventilation and blood gases. Phrenic nerve stimulators were implanted bilaterally in eight and unilaterally in two patients. One patient died 3 weeks postoperatively from pneumonia, the remaining patients are entirely independent of respirator at a mean follow-up time of 20 months. Postoperative studies showed sufficient ventilation with diaphragm pacing in both sitting and recumbent body position. Their quality of life has improved. They still require permanent supervision and help with activities of daily life but all except one live in their homes. They can talk and some of them even attend school.