Does Diaphragm Pacing for Bilateral Phrenic Nerve Paralysis Improve Function or Quality of Life?

The phrenic nerve is a nerve that originates in the neck (C3-C5) and passes down between the lung and heart to reach the diaphragm. It controls the diaphragm which is the primary muscle involved in breathing. Injuries of the phrenic nerve can occur after trauma such as falls, blunt trauma, after penetrating injuries or in car accidents, iatrogenic nerve injury during surgery in the neck and chest. Phrenic nerve pacing (PNP), or ?diaphragm pacing?, is the application of rhythmic electrical impulses to the diaphragm, resulting in respiration for patients who would be otherwise dependent on a mechanical ventilator. Phrenic nerve stimulators are indicated for selected patients with partial or complete respiratory insufficiency? and ?can be only effective if the patient has an intact phrenic nerve and diaphragm, which means in patients with spinal cord injuries, central sleep apnea and in patients with lesion of central nervous system. In contrast, trauma below C2 usually does not allow pacing, because the cell bodies of the phrenic nerves are damaged. This kind of treatment can lead to a significant improvement in the quality of life of ventilator-dependent quadriplegic individuals. It can improve pulmonary function and reduce the incidence of pulmonary infections. In addition, it improves quality of speech and olfaction which leads to much better quality of life and higher rates of social participation. We would like to demonstrate a case of a nineteen years old patient that was admitted to the ER department in Clinical Center of Serbia as an emergency case with penetrating wound injury after a gunshot wound to the neck. Data from the literature, which have been also confirmed with our individual experience suggest that the phrenic nerve pacing begins in cases that there is no recovery of nerve not earlier than three and no later than six months after the injury when the results are the most appropriate. Most patients with diaphragmatic pacemakers continue to need tracheostomies and mechanical ventilators as a back-up to their pacemakers. It is important to note that diaphragmatic pace makers only improve inspiratory function and do not target expiratory functions such as coughing and clearing secretions. Finally, the extremely high cost of the device itself, with modest results of the implementation of the device, gives a basis to observe it with great criticism, especially in countries with lower economic status.

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Cardiovascular surgery complication and the benefits of pulmonary rehabilitation in preventing COPD exacerbation

Balneo Research Journal ◽

10.12680/balneo.2020.314 ◽

2020 ◽

pp. 45-49

Author(s):

Ionut STANCIU ◽

Any DOCU AXELERAD ◽

Otilia APETREI CORDUNEANU ◽

Elena DANTES

Keyword(s):

Quality Of Life ◽

Functional Status ◽

Phrenic Nerve ◽

Pulmonary Rehabilitation ◽

Airflow Obstruction ◽

Pharmacological Intervention ◽

Nerve Paralysis ◽

Functional Features ◽

Respiratory Rehabilitation

Introduction. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide, and the burden of the disease is constantly increasing. Although COPD is primarily characterized by the presence of airflow obstruction, in many patients, it is associated with systemic manifestations that can result in impaired functional capacity, reduced quality of life, and increased mortality. Pulmonary rehabilitation (PR) consists of a multidisciplinary and comprehensive non-pharmacological intervention that is designed to improve health status in COPD patients, along with pharmacologic treatment. PR has also been shown to improve the diaphragmatic mobility in patients with different conditions that affect the diaphragm. The aim of the paper is to describe the clinical and functional features of a COPD patient with unilateral paralysis of the phrenic nerve and the role of PR as a major component of the case management. Material and method. This paper presents the case of a 66-year-old patient, diagnosed with COPD Gold stage III, which suffered a surgical intervention for an aorta aneurysm and later complicated with phrenic nerve injury and left diaphragmatic paralysis. This condition worsened the respiratory functional status and the patient needed a tailored treatment. Results and discussions. The treatment included besides inhaled dual long acting bronchodilator and corticoid therapy, pulmonary rehabilitation with complex methods, consisting in training of the respiratory musculature and techniques of bronchial drainage using devices with positive inspiratory and expiratory pressure, with good clinical and functional outcomes. A PR program should be included into a personalized management plan, along with pharmacological therapy. Conclusion. Although there is no standard treatment for COPD associated with unilateral paralysis of the phrenic nerve, it is important to diagnose these conditions promptly, and to recommend the adequate pharmacological treatment for controlling the symptoms along with a personalized complex respiratory rehabilitation program, in order to increase functional status and quality of life. Key words: respiratory rehabilitation, COPD, phrenic nerve paralysis

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