title: Management of chronic ventilatory insufficiency with electrical diaphragm pacing.
abstract: We have had experience with diaphragm pacing in 24 patients at the Toronto Western Hospital. Fourteen patients have undergone bilateral implants to treat chronic ventilatory insufficiency (CVI) caused by traumatic tetraplegia at the C1/2 level (eight patients), neurogenic apnea (five) and one case of neonatal apnea. Unilateral stimulators for nocturnal pacing have been implanted in five patients with central alveolar hypoventilation (sleep apnea) and five patients who suffered CVI resulting from various etiologies. Of the patients who were ventilatory dependent, 80% were successfully weaned and in the entire series, 58% of the patients are living. Diaphragm pacing was successful in 67%, partially successful in 8% and ineffective in 25%. The major complications were: death by pneumonia, failure of the radio receivers, and infection. Diaphragm pacing is the treatment of choice for patients who are ventilator dependent and tetraplegic from upper cervical trauma or in some cases of neurogenic apnea; it may be life saving for patients who suffer central alveolar hypoventilation.
authors.affiliation: Department of Surgery (Neurosurgery), Toronto Western Hospital, Ontario, Canada.
authors.forename: R G
authors.initials: RG
authors.lastname: Vanderlinden
authors.forename: S W
authors.initials: SW
authors.lastname: Epstein
authors.forename: R H
authors.initials: RH
authors.lastname: Hyland
authors.forename: H S
authors.initials: HS
authors.lastname: Smythe
authors.forename: L D
authors.initials: LD
authors.lastname: Vanderlinden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003964:Diaphragm / Q000294:innervation / Q000503:physiopathology*; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D014132:Trachea / Q000601:surgery