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Peripheral Nerve Interface Applications, Respiratory Pacing

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Encyclopedia of Computational Neuroscience

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Synonyms

Diaphragm pacing; Phrenic nerve pacing; Respiratory electrical stimulation

Definition

Respiratory pacing is a technique that uses patterned repetitive electrical stimulation to activate ventilatory muscles in order to increase airflow in the lungs. Respiratory pacing is usually used in cases of cervical spinal cord injury (SCI) where the connection between the respiratory drive centers and the respiratory nerves has been lost, though other disorders may also be candidates. Pacing may be delivered by peripheral nerve stimulation (typically the phrenic nerve that innervates the diaphragm), intramuscular stimulation (typically the thoracic diaphragm), or spinal cord stimulation. Respiratory pacing is used as an alternative to mechanical ventilation which may cause trauma to the lungs and other respiratory and psychological complications.

Detailed Description

Background

Respiratory pacing provides a solution for individuals with chronic ventilatory insufficiency or those...

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References

  • Abbas JJ, Triolo RJ (1997) Experimental evaluation of an adaptive feedforward controller for use in functional neuromuscular stimulation systems. IEEE Trans Rehabil Eng 5:12–22

    CAS  PubMed  Google Scholar 

  • Aboussouan L (2009) Mechanisms of exercise limitation and pulmonary rehabilitation for patients with neuromuscular disease. Chron Respir Dis 6:231–249

    CAS  PubMed  Google Scholar 

  • Abraham WT, Jagielski D, Oldenburg O, Augostini R, Krueger S, Kolodziej A, Gutleben K-J, Khayat R, Merliss A, Harsch MR, Holcomb RG, Javaheri S, Ponikowski P (2015) Phrenic nerve stimulation for the treatment of central sleep apnea. JACC Heart Fail 3:360–369

    PubMed  Google Scholar 

  • Ahmed M (2007) Hering-Breuer reflex and pre-Botzinger complex: a literature survey. J Bangladesh Soc Physiol 2:89–94

    Google Scholar 

  • Amirjani N, Kiernan MC, McKenzie DK, Butler JE, Gandevia SC (2012) Is there a case for diaphragm pacing for amyotrophic lateral sclerosis patients? Amyotroph Lateral Scler 13:521–527

    PubMed  Google Scholar 

  • Costanzo MR, Ponikowski P, Javaheri S, Augostini R, Goldberg L, Holcomb R, Kao A, Khayat RN, Oldenburg O, Stellbrink C, Abraham WT (2016) Transvenous neurostimulation for central sleep apnoea: a randomised controlled trial. Lancet 388:974–982

    PubMed  Google Scholar 

  • Crago PE, Mortimer TJ, Peckham PH (1980a) Closed-loop control of force during electrical stimulation of muscle. IEEE Trans Biomed Eng 27:306–312

    CAS  PubMed  Google Scholar 

  • Crago PE, Peckham PH, Thrope GB (1980b) Modulation of muscle force by recruitment during intramuscular stimulation. IEEE Trans Biomed Eng 27:679–684

    CAS  PubMed  Google Scholar 

  • Dean JB, Nattie EE (2010) Central CO2 chemoreception in cardiorespiratory control. J Appl Physiol 108:976–978

    PubMed  PubMed Central  Google Scholar 

  • Diep B, Wang A, Kun S, McComb JG, Shaul DB, Shin CE, Keens TG, Perez IA (2015) Diaphragm pacing without tracheostomy in congenital central hypoventilation syndrome patients. Respiration 89:534–538

    PubMed  Google Scholar 

  • DiMarco AF (1999) Diaphragm pacing in patients with spinal cord injury. Topics Spinal Cord Inj Rehabil 5:6–20

    Google Scholar 

  • DiMarco AF (2005) Restoration of respiratory muscle function following spinal cord injury: review of electrical and magnetic stimulation techniques. Respir Physiol Neurobiol 147:273–287

    PubMed  Google Scholar 

  • DiMarco AF (2009) Phrenic nerve stimulation in patients with spinal cord injury. Respir Physiol Neurobiol 169:200–209

    PubMed  Google Scholar 

  • DiMarco AF (2018) Diaphragm pacing. Clin Chest Med 39:459–471

    PubMed  Google Scholar 

  • DiMarco AF, Kowalski KE (2013) Spinal pathways mediating phrenic activation during high frequency spinal cord stimulation. Respir Physiol Neurobiol 186:1–6

    PubMed  Google Scholar 

  • DiMarco AF, Onders RP, Kowalski KE, Miller ME, Ferek S, Mortimer TJ (2002) Phrenic nerve pacing in a tetraplegic patient via intramuscular diaphragm electrodes. Am J Respir Crit Care Med 166:1604–1606

    PubMed  Google Scholar 

  • DiMarco AF, Takaoka Y, Kowalski KE (2005) Combined intercostal and diaphragm pacing to provide artificial ventilation in patients with tetraplegia. Arch Phys Med Rehabil 86:1200–1207

    PubMed  Google Scholar 

  • DiMarco AF, Kowalski KE, Geertman RT, Hromyak DR (2009) Lower thoracic spinal cord stimulation to restore cough in patients with spinal cord injury: results of a National Institutes of Health-sponsored clinical trial. Part I: methodology and effectiveness of expiratory muscle activation. Arch Phys Med Rehabil 90:717–725

    PubMed  PubMed Central  Google Scholar 

  • DiMarco AF, Geertman RT, Tabbaa K, Kowalski KE (2019) Complete restoration of respiratory muscle function in three subjects with spinal cord injury: pilot interventional clinical trial. Am J Phys Med Rehabil 98:43–50

    PubMed  Google Scholar 

  • Durfee WK, Palmer KI (1994) Estimation of force-activation, force-length, and force-velocity properties in isolated, electrically stimulated muscle. IEEE Trans Biomed Eng 41:205–216

    CAS  PubMed  Google Scholar 

  • Fodstad H (1987) The Swedish experience in phrenic nerve stimulation. Pacing Clin Electrophysiol 10:246–251

    CAS  PubMed  Google Scholar 

  • Glenn WWL (1978) Diaphragm pacing: present status. Pacing Clin Electrophysiol 1:357–370

    CAS  PubMed  Google Scholar 

  • Glenn WWL, Hageman JH, Mauro A (1964) Electrical stimulation of excitable tissue by radio-frequency transmission. Ann Surg 160:335–350

    Google Scholar 

  • Glenn WWL, Holcomb WG, Shaw RK, Hogan JF, Holschuh KR (1976) Long term ventilatory support by diaphragm pacing in quadriplegia. Ann Surg 183:566–577

    CAS  PubMed  PubMed Central  Google Scholar 

  • Glenn WWL, Hogan JF, Loke JS, Ciesielski TE, Phelps ML, Rowedder R (1984) Ventilatory support by pacing of the conditioned diaphragm in quadriplegia. N Engl J Med 310:1150–1155

    CAS  PubMed  Google Scholar 

  • Guyenet PG (2014) Regulation of breathing and autonomic outflows by chemoreceptors. Compr Physiol 4:1511–1562

    PubMed  PubMed Central  Google Scholar 

  • Guyenet PG, Bayliss DA (2015) Neural control of breathing and CO2 homeostasis. Neuron 87:946–961

    CAS  PubMed  PubMed Central  Google Scholar 

  • Hachmann JT, Grahn PJ, Calvert JS, Drubach DI, Lee KH, Lavrov IA (2017) Electrical neuromodulation of the respiratory system after spinal cord injury. Mayo Clin Proc 92:1401–1414

    PubMed  Google Scholar 

  • Harris MB, St John WM (2003) Tonic pulmonary stretch receptor feedback modulates both eupnea and gasping in an in situ rat preparation. Am J Physiol Regul Integr Comp Physiol 285:R215–R221

    CAS  PubMed  Google Scholar 

  • Jaeger RJ, Turba RM, Yarkony GM, Roth EJ (1993) Cough in spinal cord injured patients: comparison of three methods to produce cough. Arch Phys Med Rehabil 74:1358–1361

    CAS  PubMed  Google Scholar 

  • Jarosz R, Littlepage MM, Creasey G, McKenna SL (2012) Functional electrical stimulation in spinal cord injury respiratory care. Topics Spinal Cord Inj Rehabil 18:315–321

    Google Scholar 

  • Kasi A, Perez I, Kun S, Keens T (2016) Congenital central hypoventilation syndrome: diagnostic and management challenges. Pediatr Health Med Ther 7:99–107

    CAS  Google Scholar 

  • Kowalski KE, Hsieh YH, Dick TE, DiMarco AF (2013) Diaphragm activation via high frequency spinal cord stimulation in a rodent model of spinal cord injury. Exp Neurol 247:689–693

    PubMed  PubMed Central  Google Scholar 

  • Krause JS, DeVivo MJ, Jackson AB (2004) Health status, community integration, and economic risk factors for mortality after spinal cord injury. Arch Phys Med Rehabil 85:1764–1773

    PubMed  Google Scholar 

  • Le Pimpec-Barthes F, Legras A, Arame A, Pricopi C, Boucherie JC, Badia A, Panzini CM (2016) Diaphragm pacing: the state of the art. J Thorac Dis 8:S376–S386

    PubMed  PubMed Central  Google Scholar 

  • Lee BB, Boswell-Ruys C, Butler JE, Gandevia SC (2008) Surface functional electrical stimulation of the abdominal muscles to enhance cough and assist tracheostomy decannulation after high-level spinal cord injury. J Spinal Cord Med 31:78–82

    PubMed  PubMed Central  Google Scholar 

  • Leiter JC, Manning HL (2010) The Hering-Breuer reflex, feedback control, and mechanical ventilation: the promise of neurally adjusted ventilatory assist. Crit Care Med 38:1915–1916

    CAS  PubMed  Google Scholar 

  • Lindsey BG, Rybak IA, Smith JC (2012) Computational models and emergent properties of respiratory neural networks. Compr Physiol 2:1619–1670

    PubMed  PubMed Central  Google Scholar 

  • McCaughey EJ, Borotkanics RJ, Gollee H, Folz RJ, Mclachlan AJ (2016) Abdominal functional electrical stimulation to improve respiratory function after spinal cord injury: a systematic review and meta-analysis. Spinal Cord 54:628–639

    CAS  PubMed  Google Scholar 

  • McDermott CJ et al (2015) Safety and efficacy of diaphragm pacing in patients with respiratory insufficiency due to amyotrophic lateral sclerosis (DiPALS): a multicentre, open-label, randomised controlled trial. Lancet Neurol 14:883–892

    Google Scholar 

  • Morgan JA, Ginsburg ME, Sonett JR et al (2003) Advanced thoracoscopic procedures are facilitated by computer-aided robotic technology. Eur J Cardiothorac Surg 23:883–887

    Google Scholar 

  • Nochomovitz ML, Dimarco AF, Mortimer TJ, Cherniack NS (1983) Diaphragm activation with intramuscular stimulation in dogs. Am Rev Respir Dis 127:325–329

    CAS  PubMed  Google Scholar 

  • Nochomovitz ML, Hopkins M, Brodkey J, Montenegro H, Mortimer TJ, Cherniack NS (1984) Conditioning of the diaphragm with phrenic nerve stimulation after prolonged disuse. Am Rev Respir Dis 130:685–688

    CAS  PubMed  Google Scholar 

  • Nochomovitz ML, Peterson DK, Stellato TA (1988) Electrical activation of the diaphragm. Clin Chest Med 9:349–358

    CAS  PubMed  Google Scholar 

  • Onders RP (2012) Functional electrical stimulation: restoration of respiratory function. Handb Clin Neurol 109:275–282

    Google Scholar 

  • Onders RP, Aiyar H, Mortimer TJ (2004a) Characterization of the human diaphragm muscle with respect to the phrenic nerve motor points for diaphragmatic pacing. Am Surg 70:241–247

    PubMed  Google Scholar 

  • Onders RP, DiMarco AF, Ignagni AR, Aiyar H, Mortimer TJ (2004b) Mapping the phrenic nerve motor point: the key to a successful laparoscopic diaphragm pacing system in the first human series. Surgery 136:819–826

    PubMed  Google Scholar 

  • Onders RP, DiMarco AF, Ignagni AR, Mortimer JT (2005) The learning curve for investigational surgery: lessons learned from laparoscopic diaphragm pacing for chronic ventilator dependence. Surg Endosc 19:633–637

    CAS  PubMed  Google Scholar 

  • Peterson DK, Nochomovitz ML, DiMarco AF, Mortimer TJ (1986) Intramuscular electrical activation of the phrenic nerve. IEEE Trans Biomed Eng 33:342–351

    CAS  PubMed  Google Scholar 

  • Ponikowski P et al (2012) Transvenous phrenic nerve stimulation for the treatment of central sleep apnoea in heart failure. Eur Heart J 33:889–894

    PubMed  Google Scholar 

  • Reynolds S, Ebner A, Meffen T, Thakkar V, Gani M, Taylor K, Clark L, Sadarangani G, Meyyappan R, Sandoval R, Rohrs E, Hoffer JA (2017) Diaphragm activation in ventilated patients using a novel transvenous phrenic nerve pacing catheter. Crit Care Med 45:e691–e694

    PubMed  Google Scholar 

  • Sarnoff SJ, Hardenbergh E, Whittenberger JL (1948) Electrophrenic respiration. Am J Phys 155:1–9

    CAS  Google Scholar 

  • Sarnoff SJ, Maloney JV, Sarnoff LC, Ferris BG, Whittenberger JL (1950) Electrophrenic respiration in acute bulbar poliomyelitis; its use in management of respiratory irregularities. J Am Med Assoc 143:1383–1390

    CAS  PubMed  Google Scholar 

  • Schelegle ES (2003) Functional morphology and physiology of slowly adapting pulmonary stretch receptors. Anat Rec 270A:11–16

    Google Scholar 

  • Scherer K, Bedlack RS (2012) Diaphragm pacing in amyotrophic lateral sclerosis: a literature review. Muscle Nerve 46:1–8

    PubMed  Google Scholar 

  • Shaul DB, Danielson PD, McComb JG, Keens TG (2002) Thoracoscopic placement of phrenic nerve electrodes for diaphragmatic pacing in children. J Pediatr Surg 37:974–978

    PubMed  Google Scholar 

  • Shavelle RM, DeVivo MJ, Strauss DJ, Paculdo DR, Lammertse DP, Day SM (2006) Long-term survival of persons ventilator dependent after spinal cord injury. J Spinal Cord Med 29:511–519

    PubMed  PubMed Central  Google Scholar 

  • Vanderlinden RG, Epstein SW, Hyland RH, Smythe HS, Vanderlinden LD (1988) Management of chronic ventilatory insufficiency with electrical diaphragm pacing. Can J Neurol Sci/Journal Canadien des Sciences Neurologiques 15:63–67

    CAS  PubMed  Google Scholar 

  • Venkatasubramanian G, Jung R, Sweeney JD (2006) Functional electrical stimulation. In: Encyclopedia of medical devices and instrumentation. Wiley, Hoboken, pp 369–370

    Google Scholar 

  • Wuerker RB, McPhedran AM, Henneman E (1965) Properties of motor units in a heterogeneous pale muscle (M. Gastrocnemious) of the cat. J Neurophysiol 28:85–99

    PubMed  Google Scholar 

  • Zimmer MB, Nantwi K, Goshgarian HG (2007) Effect of spinal cord injury on the respiratory system: basic research and current clinical treatment options. J Spinal Cord Med 30:319–330

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Adaptive Neural Systems Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL, USA

    Brian Hillen, Ricardo Siu & Ranu Jung

Authors
  1. Brian Hillen
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  2. Ricardo Siu
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  3. Ranu Jung
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Corresponding author

Correspondence to Brian Hillen .

Editor information

Editors and Affiliations

  1. Atlanta, GA, USA

    Dieter Jaeger

  2. Department of Biomedical Engineering, Florida International University, Miami, FL, USA

    Ranu Jung

Section Editor information

  1. Department of Mechanical Engineering and Carnegie Mellon Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA

    Douglas Weber Ph.D.

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Hillen, B., Siu, R., Jung, R. (2020). Peripheral Nerve Interface Applications, Respiratory Pacing. In: Jaeger, D., Jung, R. (eds) Encyclopedia of Computational Neuroscience. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7320-6_205-2

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  • DOI: https://doi.org/10.1007/978-1-4614-7320-6_205-2

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  • Print ISBN: 978-1-4614-7320-6

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Chapter history

  1. Latest

    Peripheral Nerve Interface Applications, Respiratory Pacing
    Published:
    30 July 2020

    DOI: https://doi.org/10.1007/978-1-4614-7320-6_205-2

  2. Original

    Peripheral Nerve Interface Applications: Respiratory Pacing
    Published:
    25 March 2014

    DOI: https://doi.org/10.1007/978-1-4614-7320-6_205-1

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