title: Respiratory neuromodulation in patients with neurological pathologies: for whom and how?
abstract: Implanted phrenic nerve stimulation is a technique restoring spontaneous breathing in patients with respiratory control failure, leading to being dependent on mechanical ventilation. This is the case for quadriplegic patients with a high spinal cord injury level and for patients with congenital central hypoventilation syndrome. The electrophysiological diaphragm explorations permits better patient selection, confirming on the one hand a definite issue with central respiratory command and on the other hand the integrity of diaphragmatic phrenic nerves. Today there are two different phrenic stimulation techniques: the quadripolar intrathoracic stimulation and the bipolar intradiaphragmatic stimulation. Both techniques allow patients to be weaned off their mechanical ventilator, improving dramatically their quality of life. In fact, one of the systems (phrenic intradiaphragmatic stimulation) was granted social security reimbursement in 2009, and now both are reimbursed. In the future, phrenic intradiaphragmatic stimulation may find its place in the intensive care unit, for patients needing it temporarily, for example, after certain surgeries with respiratory complications as well as diaphragmatic atrophies induced by prolonged mechanical ventilation.
authors.affiliation: Service de pneumologie et réanimation médicale (département « R3S »), groupe hospitalier Pitié-Salpêtrière - Charles-Foix, AP-HP, 75013 Paris, France; Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, UPMC - université Paris 06, Sorbonne universités, 75013 Paris, France. Electronic address: jesus.gonzalez@aphp.fr.
authors.forename: J
authors.initials: J
authors.lastname: Gonzalez-Bermejo
authors.affiliation: Service de pneumologie et réanimation médicale (département « R3S »), groupe hospitalier Pitié-Salpêtrière - Charles-Foix, AP-HP, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: LLontop
authors.affiliation: Service de pneumologie et réanimation médicale (département « R3S »), groupe hospitalier Pitié-Salpêtrière - Charles-Foix, AP-HP, 75013 Paris, France; Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, UPMC - université Paris 06, Sorbonne universités, 75013 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Similowski
authors.affiliation: Service de pneumologie et réanimation médicale (département « R3S »), groupe hospitalier Pitié-Salpêtrière - Charles-Foix, AP-HP, 75013 Paris, France; Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, UPMC - université Paris 06, Sorbonne universités, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Morélot-Panzini
mesh_terms: D000075202:Contraindications; D003964:Diaphragm / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D006801:Humans; D018579:Patient Selection; D010791:Phrenic Nerve; D011782:Quadriplegia / Q000150:complications / Q000503:physiopathology; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000534:rehabilitation*
keywords: Chronic respiratory failure; Phrenic nerve pacing; Quadriplegia