Long-term evaluation of phrenic nerve pacing for respiratory failure due to high cervical spinal cord injury.
OBJECTIVE
Phrenic nerve pacing is a method of respiratory support that can replace mechanical ventilation in high-level cervical spinal cord injury patients with diaphragmatic paralysis. Our objective was to evaluate survival and long-term quality of life in patients with external respiratory support by PNP vs volumetric respirator in patients with severe respiratory insufficiency due to a high-level spinal cord injury.


METHODS
This is a retrospective review study of a prospectively collected database for evaluate the survival and a questionnaire for quality of life has been collected face-to-face or by telephone at present.


METHODS
Cervical SCI patients with permanent respiratory support (PNP or MV).


METHODS
Long-term evaluation of a cohort of PNP-supported patients. We performed a comparison between these patients and volumetric respirator-supported patients. For survival analysis, we used the Kaplan-Meier method and Cox proportional hazards model. The health-related quality of life was assessed with SF-36 questionnaire, a general HRQL evaluation.


RESULTS
One hundred twenty six patients on permanent respiratory support were evaluated during the study period. Of these, 38 were on PNP and 88 were mechanically ventilated. Paced patients were younger and had a longer survival, but in a multivariate analysis adjusted for age using a multiple logistic correlation we found that length of survival was greater for PNP patients. In terms of HRQL, the PNP-supported patients showed better results in terms of social functioning.


CONCLUSIONS
PNP is a stable and effective method of long-term respiratory support in this type of patients (SCI patients dependent on external respiratory support). In these patients it improves the length of survival and some social issues by quality of life when compared with patients under MV.
Service of Internal Medicine, ICU and Pneumology Unit, Hospital Nacional de Parapléjicos, Toledo, Spain. fjromero@sescam.jccm.es
F J
FJ
Romero
C
C
Gambarrutta
A
A
Garcia-Forcada
M A
MA
Marín
E
E
Diaz de la Lastra
F
F
Paz
M T
MT
Fernandez-Dorado
J
J
Mazaira
D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries*; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000502:physiology*; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D055815:Young Adult