title: Inspiratory muscle pacing in spinal cord injury: case report and clinical commentary.
abstract: OBJECTIVE
  A significant fraction of patients with cervical spinal cord injury suffer from respiratory muscle paralysis and dependence on chronic mechanical ventilation. In selected patients, diaphragm pacing (DP) through electrical stimulation of the phrenic nerves provides an alternative to mechanical ventilation with significant advantages in life quality.
  
  
  METHODS
  A case report of an individual who successfully underwent DP using intramuscular diaphragm electrodes. A brief review of the state of the art of DP including the clinical benefits of DP, patient selection and evaluation, description of equipment, methods of transition from mechanical ventilation to DP, potential complications and side effects, long-term outcome, and potential future developments in this field is included.
  
  
  RESULTS
  Several available DP systems are available, including conventional ones in which electrodes are positioned directly on the phrenic nerves through thoracotomy and less invasive systems in which electrodes are placed within the diaphragm through laparoscopy. For patients with only unilateral phrenic nerve function, a combined intercostal and unilateral diaphragm pacing system is under development.
  
  
  CONCLUSIONS
  In patients with ventilator-dependent tetraplegia, there are alternative methods of ventilatory support, which offer substantial benefits compared to mechanical ventilation.
authors.affiliation: Department of Physiology and Biophysics, Case Western Reserve University, MetroHealth Medical Center, Rammelkamp Center for Education & Research, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA. afd3@po.cwru.edu
authors.forename: Anthony F
authors.initials: AF
authors.lastname: DiMarco
authors.forename: Raymond P
authors.initials: RP
authors.lastname: Onders
authors.forename: Anthony
authors.initials: A
authors.lastname: Ignagni
authors.forename: Krzysztof E
authors.initials: KE
authors.lastname: Kowalski
mesh_terms: D003964:Diaphragm / Q000294:innervation; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D004567:Electrodes, Implanted; D004867:Equipment Design; D007839:Functional Laterality / Q000502:physiology; D049669:History, 16th Century; D006801:Humans; D001239:Inhalation / Q000502:physiology*; D010535:Laparoscopy; D008297:Male; D010791:Phrenic Nerve / Q000503:physiopathology*; D011782:Quadriplegia / Q000503:physiopathology / Q000534:rehabilitation; D012132:Respiratory Muscles / Q000294:innervation*; D012133:Respiratory Paralysis / Q000503:physiopathology / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000534:rehabilitation*