Assisted Breathing with a Diaphragm Pacing System: A Systematic Review

Area of Science:

• Neurology
• Pulmonology
• Biomedical Engineering

Background:

• Neurological dysfunction often leads to respiratory failure, necessitating mechanical ventilation.
• Mechanical ventilation presents economic burdens and risks of ventilator-associated complications.
• Diaphragm pacing systems (DPS) offer an alternative respiratory support method for specific patient groups.

Purpose of the Study:

• To systematically review the literature on the safety and efficacy of DPS.
• To assess DPS use in patients with respiratory failure due to amyotrophic lateral sclerosis (ALS) or cervical spinal cord injuries (SCI).

Main Methods:

• A comprehensive literature search was conducted across multiple databases from July 10-30, 2018.
• Included studies comprised randomized controlled trials, case-control studies, cohort studies, and case reports.
• Safety (complications, adverse events) and efficacy (survival, sleep improvement) were primary outcomes.

Main Results:

• A total of 197 articles were initially identified, with several study designs included for ALS and SCI populations.
• Complications and adverse events were more frequent in patients receiving DPS compared to controls.
• Efficacy outcomes demonstrated inconsistency, particularly in studies involving ALS patients.

Conclusions:

• The current evidence suggests a higher incidence of complications and adverse events associated with DPS.
• Inconsistent efficacy data limits the support for widespread DPS adoption.
• The study does not support the use of DPS for managing respiratory failure in ALS or cervical SCI patients based on current safety and efficacy data.