title: Electric ventilation: indications for and technical aspects of diaphragm pacing stimulation surgical implantation.
abstract: OBJECTIVE
  Patients with high cervical spinal cord injury are usually dependent on mechanical ventilation support, which, albeit life saving, is associated with complications and decreased life expectancy because of respiratory infections. Diaphragm pacing stimulation (DPS), sometimes referred to as electric ventilation, induces inhalation by stimulating the inspiratory muscles. Our objective was to highlight the indications for and some aspects of the surgical technique employed in the laparoscopic insertion of the DPS electrodes, as well as to describe five cases of tetraplegic patients submitted to the technique.
  
  
  METHODS
  Patient selection involved transcutaneous phrenic nerve studies in order to determine whether the phrenic nerves were preserved. The surgical approach was traditional laparoscopy, with four ports. The initial step was electrical mapping in order to locate the "motor points" (the points at which stimulation would cause maximal contraction of the diaphragm). If the diaphragm mapping was successful, four electrodes were implanted into the abdominal surface of the diaphragm, two on each side, to stimulate the branches of the phrenic nerve.
  
  
  RESULTS
  Of the five patients, three could breathe using DPS alone for more than 24 h, one could do so for more than 6 h, and one could not do so at all.
  
  
  CONCLUSIONS
  Although a longer follow-up period is needed in order to reach definitive conclusions, the initial results have been promising. At this writing, most of our patients have been able to remain ventilator-free for long periods of time.
authors.affiliation: InCor, Heart Institute – University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. tedde@usp.br
authors.forename: Miguel Lia
authors.initials: ML
authors.lastname: Tedde
authors.forename: Raymond P
authors.initials: RP
authors.lastname: Onders
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.forename: Silvia Gelas
authors.initials: SG
authors.lastname: Lage
authors.forename: Gerson
authors.initials: G
authors.lastname: Ballester
authors.forename: Mario Wilson Iersolino
authors.initials: MW
authors.lastname: Brotto
authors.forename: Erica Mie
authors.initials: EM
authors.lastname: Okumura
authors.forename: Fabio Biscegli
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D000293:Adolescent; D000328:Adult; D003964:Diaphragm / Q000294:innervation*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D008297:Male; D012133:Respiratory Paralysis / Q000209:etiology / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods; D055815:Young Adult