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Combined intercostal and diaphragm pacing to provide artificial ventilation in patients with tetraplegia
Anthony F DiMarco1, Yoshiro Takaoka, Krzysztof E Kowalski
1Departments of Physiology and Biophysics, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA. afd3@cwru.edu
Objective:
To evaluate the usefulness of combined intercostal and diaphragm pacing to maintain independence from mechanical ventilation.
Design:
A prospective trial.
Setting:
Clinical research center at a large tertiary hospital.
Participants:
Four ventilator-dependent subjects with spinal cord injury with only unilateral phrenic nerve function.
Intervention:
During an initial surgical procedure, a multipolar epidural disk electrode was positioned on the ventral surface of the upper-thoracic spinal cord via a hemilaminectomy to activate the inspiratory intercostal muscles. A phrenic nerve electrode was implanted unilaterally via the thoracic approach.
Main Outcome Measures:
Inspired volume production and duration that subjects could be comfortably maintained when off mechanical ventilatory support.
Results:
Initial maximum inspired volumes from combined intercostal and diaphragm stimulation ranged between .23 and .93L and significantly increased over the course of reconditioning period to between 0.55 and 1.31L; subjects could be maintained off mechanical ventilation between 16 and 24 hours a day.
Conclusions:
Combined intercostal and unilateral diaphragm pacing may be a useful therapeutic modality capable of maintaining long-term ventilatory support in patients with only unilateral phrenic nerve function.
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