Summary
Diaphragm pacing with electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. The device, however, is not readily available. We tested the same spinal cord stimulator we use for pain control in phrenic nerve stimulation.
We implanted a spinal cord stimulator (Itrel 3 or X-trel, Medtronic, MN) in 6 patients with chronic hypoventilation because of brainstem or high cervical cord dysfunction. The stimulation electrode was placed along the right phrenic nerve in the neck, and the device was implanted in the anterior chest. We used the cyclic mode, and set the parameters at 1 second ramp up, 2 seconds on, 3 seconds off. The pulse width and the frequency were set at 150 microseconds and 21Hz, respectively. The amplitude of the output was adjusted to obtain sufficient tidal volume and to maintain PaCO2 at around 40mm Hg.
During a follow-up period up to four years, stable and sufficient ventilation was observed in all patients without any complications. Although further long follow-up is necessary, diaphragm pacing with the spinal cord stimulator is feasible and effective for the treatment of the central hypoventilation syndrome.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Chervin RD, Guilleminault C (1997) Diaphragm pacing for respiratory insufficiency. J Clin Neurophysiol 14: 369–377
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
Elefteriades JA, Quin JA (2002) Diaphragm pacing. Ann Thorac Surg 73: 691–692
Elefteriades JA, Quin JA, Hogan JF, Holcomb WG, Letsou GV, Chlosta WF, Glenn WW (2002) Long-term follow-up of pacing of the conditioned diaphragm in quadriplegia. Pacing Clin Electrophysiol 25: 897–906
Garrido-Garcia H, Mazaira Alvarez J, Martin Escribano P (1998) Treatment of chronic ventilatory failure using a diaphragmatic pacemaker. Spinal Cord 36: 310–314
Glenn WW, Holcomb WG, Shaw RK, Hogan JF, Holschuh KR (1976) Long-term ventilatory support by diaphragm pacing in quadriplegia. Ann Surg 183: 566–577
Glenn WW, Phelps ML (1985) Diaphragm pacing by electrical stimulation of the phrenic nerve. Neurosurgery 17: 974–984
Mitsuyama T, Taira T, Takeda N, Hori T (2003) Diaphragm pacing with the spinal cord stimulator. Acta Neurochir Suppl 87: 89–92
Onders RP, Dimarco AF, Ignagni AR, Aiyar H, Mortimer JT (2004) Mapping the phrenic nerve motor point: the key to a successful laparoscopic diaphragm pacing system in the first human series. Surgery 136: 819–826
Taira T, Takeda N, Itoh K, Oikawa A, Hori T (2003) Phrenic nerve stimulation for diaphragm pacing with a spinal cord stimulator: technical note. Surg Neurol 59: 128–132
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Springer-Verlag
About this chapter
Cite this chapter
Taira, T., Hori, T. (2007). Diaphragm pacing with a spinal cord stimulator: current state and future directions. In: Sakas, D.E., Simpson, B.A., Krames, E.S. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/1. Springer, Vienna. https://doi.org/10.1007/978-3-211-33079-1_39
Download citation
DOI: https://doi.org/10.1007/978-3-211-33079-1_39
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-33078-4
Online ISBN: 978-3-211-33079-1
eBook Packages: MedicineMedicine (R0)