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Diaphragm pacing: clinical and experimental results
1Department of Pediatrics, Montreal Children's Hospital, Canada.
Biology of the Neonate
|January 1, 1994
Summary
Diaphragm pacing supports breathing in patients with respiratory muscle weakness. While effective, pediatric systems experienced failures, though recent advances may improve longevity and reduce diaphragm damage.
Area of Science:
- Biomedical Engineering
- Respiratory Physiology
- Neurosurgery
Background:
- Diaphragm pacing has supported ventilation in over 400 adults and 70 children for 26 years.
- It is beneficial for conditions with absent respiratory drive, like central hypoventilation syndrome and high quadriplegia.
Purpose of the Study:
- To review the use, outcomes, and challenges of diaphragm pacing in pediatric patients.
- To evaluate the impact of specific stimulus parameters on diaphragmatic structure and function.
- To identify factors affecting system longevity and patient survival.
Main Methods:
- Analysis of 26 years of diaphragm pacing data in adult and pediatric populations.
- Histochemical, physiological, and ultrastructural analysis of diaphragmatic changes in an animal model.
- Review of system failure rates and patient outcomes in a cohort of 36 pediatric patients.
Main Results:
- Pediatric pacing requires tracheostomy and bilateral pacing, with optimal parameters including low frequency and short inspiratory time.
- Animal models showed diaphragm transformation to fatigue-resistant type 1 fibers.
- In 33 pediatric patients (96 patient-years), 26 system failures occurred with a mean time to failure of 56 months.
Conclusions:
- Diaphragm pacing is a viable ventilatory support but faces challenges with system longevity in pediatric patients.
- Specific stimulus parameters can preserve diaphragm function but alter muscle fiber type.
- Advances in receiver and electrode technology may improve long-term outcomes.