Current Status and Challenges of Diaphragm Pacing in Japan: A Systematic Review of Case Reports

Diaphragm pacing (DP) is a therapeutic intervention for ventilator-dependent patients with spinal cord injury (SCI) and congenital central hypoventilation syndrome (CCHS). Despite its availability, clinical adoption in Japan remains limited. This systematic review assesses the current state of DP in Japan, its outcomes, and its associated challenges by analyzing 10 case reports from the Ichushi database. Patients ranged from four to 50 years old, predominantly male (90%), with cervical SCI primarily due to traffic trauma (63%). DP was introduced with a median of 24 months post-injury. All patients achieved partial or complete ventilator weaning, with 27% achieving full independence. Reported benefits include improved quality of life (QOL), mobility, and social reintegration. However, complications such as respiratory muscle fatigue (54%), ventilatory issues in a seated position (18%), and pain due to stimulation (9%) were observed. Barriers to DP implementation in Japan include delayed introduction, limited interdisciplinary collaboration, and inadequate home care support. Early DP initiation, structured follow-up, and telemedicine integration could enhance outcomes. Further research is needed to establish standardized guidelines and optimize DP use.