title: Extended use of diaphragm pacing in patients with unilateral or bilateral diaphragm dysfunction: a new therapeutic option.
abstract: BACKGROUND
  Diaphragm dysfunction (DD) can cause sleep abnormalities, dyspnea, atelectasis, and respiratory failure. Historical treatments, including positive pressure ventilation or diaphragm plication, may alleviate symptoms but do not restore physiologic diaphragm function. Diaphragm pacing (DP) is approved for spinal cord-injured patients and in amyotrophic lateral sclerosis. We report a series of DD patients undergoing use of DP outside of these initial indications.
  
  
  METHODS
  This report involves a prospective, nonrandomized, interventional trial under institutional review board approval at a single institution. DP involves laparoscopic motor point mapping with implantation of intramuscular electrodes in each hemidiaphragm. Postoperatively, diaphragm conditioning ensues.
  
  
  RESULTS
  Twenty-seven patients were evaluated; all patients had symptomatic and objective hypoventilation for an average of 36 months of symptoms. Causes included idiopathic (n = 13), chest surgery (n = 5), shoulder surgery or trauma (n = 6), and others (n = 3); 17 had bilateral involvement, 6 had nonstimulable diaphragms and were not implanted, and 21 were implanted. Thirteen (62%) had substantial clinically relevant respiratory improvements. Four ventilator patients were weaned completely. Four had partial improvement, 3 had no improvement, and 1 patient was lost to follow-up for objective analysis.
  
  
  CONCLUSIONS
  This is the first report of DP being used to treat diverse causes of DD. Eighty-one percent of implanted patients experienced improvements. This success suggests a potential for a wider use of DP and areas for future research.
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH. Electronic address: Raymond.onders@uhhospitals.org.
authors.forename: Raymond P
authors.initials: RP
authors.lastname: Onders
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: MaryJo
authors.initials: M
authors.lastname: Elmo
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Cindy
authors.initials: C
authors.lastname: Kaplan
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Bashar
authors.initials: B
authors.lastname: Katirji
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Robert
authors.initials: R
authors.lastname: Schilz
mesh_terms: D000328:Adult; D000368:Aged; D003964:Diaphragm / Q000503:physiopathology* / Q000601:surgery; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058542:Implantable Neurostimulators; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012133:Respiratory Paralysis / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome