title: Importance of diaphragm thickness in amyotrophic lateral sclerosis patients with diaphragm pacing system implantation.
abstract: BACKGROUND
  Severe respiratory failure develops as a result of the involvement of the respiratory muscles in patients with amyotrophic lateral sclerosis (ALS). Implantation of diaphragm pacing system (DPS) has been carried out on ALS patients since 2005 to avoid these situations, but the importance of diaphragm thickness has not yet been established clearly.
  
  
  METHODS
  We retrospectively evaluated 34 ALS patients who had previously implanted DPS to detect the importance of diaphragm thickness. We investigated the effect of diaphragm thickness, which was measured by preoperative thorax computerized tomography on preoperative respiratory function tests (RFT), arterial blood gas (ABG) analysis, postoperative 3- and 6-month oxygen saturations and mortality.
  
  
  RESULTS
  The right diaphragm thickness was calculated as 4.60 (2.95-6.00) mm, while the left diaphragm thickness was 4.10 (2.77-6.00) mm. Six patients died during the follow-up period. We did not detect a significant relationship between ABG parameters, RFT and diaphragm thickness. However, according to our observations, the diaphragm thickness was significantly related to mortality. The right diaphragm was significantly thinner in cases that required preoperative respiratory support and had percutaneous endoscopic gastrostomy. When the cut-off values for the diaphragm thickness were accepted as 3.50 mm, significantly higher mortality among patients below this was observed.
  
  
  CONCLUSIONS
  Diaphragm thickness is an important criterion in cases for which DPS implantation is planned. We consider that avoidance of DPS implantation is more suitable for cases with a diaphragm thickness below 3.50 mm because of mortality.
authors: Thoracic Surgery Department, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
authors: Aydın
authors: A
authors: Sanli
authors: Neurology Department, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
authors: Ihsan Sukru
authors: IS
authors: Sengun
authors: Chest Diseases Department, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey. tkemalcan@yahoo.com.
authors: Kemal Can
authors: KC
authors: Tertemiz
authors: Chest Diseases Department, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
authors: Aylin Ozgen
authors: AO
authors: Alpaydin
authors: Thoracic Surgery Department, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
authors: Volkan
authors: V
authors: Karacam
authors: Thoracic Surgery Department, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
authors: Bahar Agaoglu
authors: BA
authors: Sanli
authors: Neurology Department, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
authors: Didem
authors: D
authors: Oz
authors: Physiotherapy and Rehabilitation Department, Dokuz Eylul University, Izmir, Turkey.
authors: Sevgi
authors: S
authors: Ozalevli
authors: Thoracic Surgery Department, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
authors: Nezih
authors: N
authors: Ozdemir
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000401:mortality / Q000503:physiopathology*; D003964:Diaphragm / Q000000981:diagnostic imaging* / Q000294:innervation / Q000503:physiopathology; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies
keywords: Diaphragm pacing system; Diaphragm thickness; Mortality