Multicenter review of diaphragm pacing in spinal cord injury

BackgroundCervical spinal cord injury (CSCI) is devastating and costly. Previous research has demonstrated that diaphragm pacing (DPS) is safe and improves respiratory mechanics. This may decrease hospital stays, vent days, and costs. We hypothesized DPS implantation would facilitate liberation from ventilation and would impact hospital charges.MethodsWe performed a retrospective review of patients with acute CSCI between January 2005 and May 2017. Routine demographics were collected. Patients underwent propensity matching based on age, injury severity score, ventilator days, hospital length of stay, and need for tracheostomy. We then adjusted total hospital charges by year using US Bureau of Labor Statistics annual adjusted Medical Care Prices. Bivariate and multivariate linear regression statistics were performed using STATA V.15.ResultsBetween July 2011 and May 2017, all patients with acute CSCI were evaluated for DPS implantation. 40 patients who had laparoscopic DPS implantation (DPS) were matched to 61 who did not (NO DPS). Following DPS implantation, there was a statistically significant increase in spontaneous Vt compared with NO DPS (+88 mL vs −13 mL; 95% CI 46 to 131 vs −78 to 51 mL, respectively; p=0.004). Median time to liberation after DPS was significantly shorter (10 vs 29 days; 95% CI 6.5 to 13.6 vs 23.1 to 35.3 days; p<0.001). Adjusted hospital charges were significantly lower for DPS on multivariate linear regression models controlling for year of injury, sex, race, injury severity, and age (p=0.003).DiscussionDPS implantation in patients with acute CSCI produces significant improvements in spontaneous Vt and reduces time to liberation, which translated into reduced hospital charges on a risk-adjusted, inflation-adjusted model. DPS implantation for patients with acute CSCI should be considered.Level of evidenceLevel III.

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Diaphragm Pacing in Patients with Spinal Cord Injury: A European Experience

Respiration ◽

10.1159/000517401 ◽

2021 ◽

pp. 1-7

Author(s):

Peter J. Wijkstra ◽

Hans van der Aa ◽

H. Sijbrand Hofker ◽

Francesco Curto ◽

Matteo Giacomini ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Attractive Alternative ◽

Cervical Injury ◽

Diaphragm Pacing ◽

European Experience ◽

Cord Injury ◽

Surgical Device

Background: Patients with high spinal cord injury (SCI) are unable to breathe on their own and require mechanical ventilation (MV). The long-term use of MV is associated with increased morbidity and mortality. In patients with intact phrenic nerve function, patients can be partially or completely removed from MV by directly stimulating the diaphragm motor points with a diaphragm pacing system (DPS). Objectives: We describe our multicenter European experience using DPS in SCI patients who required MV. Methods: We conducted a retrospective study of patients who were evaluated for the implantation of DPS. Patients evaluated for DPS who met the prospectively defined criteria of being at least 1 year of age, and having cervical injury resulting in a complete or partial dependency on MV were included. Patients who received DPS implants were followed for up to 1 year for device usage and safety. Results: Across 3 centers, 47 patients with high SCI were evaluated for DPS, and 34 were implanted. Twenty-one patients had 12 months of follow-up data with a median DPS use of 15 h/day (interquartile range 4, 24). Eight patients (38.1%) achieved complete MV weaning using DPS 24 h/day. Two DPS-related complications were surgical device revision and a wire eruption. No other major complications were associated with DPS use. Conclusions: Diaphragm pacing represents an attractive alternative stand-alone treatment or adjunctive therapy compared to MV in patients with high SCI. After a period of acclimation, the patients were able to reduce the daily use of MV, and many could be completely removed from MV.

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Diaphragm pacing improves respiratory mechanics in acute cervical spinal cord injury

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002809 ◽

2020 ◽

Vol 89 (3) ◽

pp. 423-428 ◽

Cited By ~ 2

Author(s):

Andrew J. Kerwin ◽

Yohan Diaz Zuniga ◽

Brian K. Yorkgitis ◽

Jennifer Mull ◽

Albert T. Hsu ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Respiratory Mechanics ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Diaphragm Pacing ◽

Cord Injury

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Diaphragm Pacing and a Model for Respiratory Rehabilitation After Spinal Cord Injury

Journal of Neurologic Physical Therapy ◽

10.1097/npt.0000000000000360 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Kathryn Cavka ◽

David D. Fuller ◽

Geneva Tonuzi ◽

Emily J. Fox

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Diaphragm Pacing ◽

Cord Injury ◽

Respiratory Rehabilitation

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Restoration Methods of Respiratory Function for Spinal Cord Injury

Mathematical Problems in Engineering ◽

10.1155/2020/7398789 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

X. Y. Gu ◽

S. Ren ◽

Y. Shi ◽

N. Wang ◽

Z. H. Tong ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Respiratory Function ◽

Respiratory Muscle Training ◽

Pulse Interval ◽

Diaphragm Pacing ◽

Treatment Methods ◽

Advantages And Disadvantages ◽

Cord Injury ◽

Function Reconstruction

Respiratory dysfunction caused by high spinal cord injury is fatal damage. Three treatment methods commonly used in the clinic, diaphragm pacing, mechanical ventilation, and respiratory muscle training, were chosen to explain the respiratory function reconstruction of spinal cord injury. The characteristics, research status, advantages, and disadvantages of these three treatment methods are reviewed. Diaphragm pacing technology has attracted much attention due to its price-friendly, efficient, and closer to physiological respiration. Therefore, the emphasis is on describing the characteristics of the stimulation waveform of diaphragm pacing and the mathematical correspondence between stimulation parameters (pulse interval, inspiratory time, etc.) and tidal volume. Meanwhile, it also briefly introduces that for patients with SCI with poor diaphragm pacing, intercostal muscle pacing can be used as the second option to restore respiratory function. Also, the development of electronic technology has promoted the emergence of closed-loop diaphragm pacing technology. Finally, we propose that the method of respiratory function reconstruction after spinal cord injury should pay more attention to physiology and the safety of surgery.

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