First reported experience with intramuscular diaphragm pacing in replacing positive pressure mechanical ventilators in children.
OBJECTIVE
Diaphragm pacing (DP) has been shown to successfully replace mechanical ventilators for adult tetraplegic patients with chronic respiratory insufficiency. This is the first report of DP in ventilator-dependent children.


METHODS
This was a prospective interventional experience under institutional review board approval. Diaphragm pacing involves outpatient laparoscopic diaphragm motor point mapping to identify the site where stimulation causes maximum diaphragm contraction with implantation of 4 percutaneous intramuscular electrodes. Diaphragm conditioning ensues to wean the child from the ventilator.


RESULTS
Six children were successfully implanted ranging from 5 to 17 years old with the smallest 15 kg in weight. Length of time on mechanical ventilation ranged from 11 days to 7.6 years with an average of 3.2 years. In all patients, DP provided tidal volumes above basal needs. Five of the patients underwent a home-based weaning program, whereas one patient who was implanted only 11 days post spinal cord injury never returned to the ventilator with DP use. Another patient was weaned from the ventilator full time but died of complications of his underlying brain stem tumor. The remaining patients weaned from the ventilator for over 14 hours a day and/or are actively conditioning their diaphragms.


CONCLUSIONS
Diaphragm pacing successfully replaced mechanical ventilators, which improves quality of life.
Division of General Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106, USA. raymond.onders@uhhospitals.org
Raymond P
RP
Onders
Todd A
TA
Ponsky
MaryJo
M
Elmo
Karen
K
Lidsky
Edward
E
Barksdale
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018849:Controlled Clinical Trials as Topic; D003964:Diaphragm / Q000294:innervation* / Q000502:physiology*; D004567:Electrodes, Implanted; D005192:Family Health; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D009469:Neuromuscular Junction / Q000502:physiology; D010791:Phrenic Nerve / Q000502:physiology*; D011175:Positive-Pressure Respiration / Q000706:statistics & numerical data*; D011782:Quadriplegia / Q000628:therapy; D012121:Respiration, Artificial / Q000009:adverse effects; D012131:Respiratory Insufficiency / Q000628:therapy; D012133:Respiratory Paralysis / Q000628:therapy; D013119:Spinal Cord Injuries / Q000628:therapy; D015300:Ventilator Weaning / Q000009:adverse effects / Q000379:methods*