Diaphragmatic Pacing in Neuromuscular Respiratory Failure

Abstract

Electrical activation of the diaphragm is a technology that allows the treatment of selected forms of respiratory failure. The diaphragmatic pacing is carried out by an implanted electrode and receiver with a pocket or tabletop external transmitter. The device electrically stimulates the phrenic nerves to contract the diaphragm rhythmically. The main indication for diaphragm pacing is for ventilator-dependent subjects after high cervical cord injury and patients with central alveolar hypoventilation. The clinical requirements are stable clinical condition and intact phrenic nerves, diaphragms, and lungs. In most patients, a training period is required to provoke a gradual conditioning effect, improving endurance to diaphragmatic fatigue. A cooperative patient, supportive family and friends, and a skilled care team are paramount conditions. Diaphragmatic pacing probably does not lengthen life, but it can increase the quality of life. Tracheostomy is usually required to overcome upper airway obstruction. Poor results are related to inadequate selection of patients, complications related to implantation, system failure, inappropriate pacing schedule, inadequate follow-up, or lack of patient compliance or family support. The long-term results of diaphragm pacing demonstrate its usefulness both in adult and pediatric patients when applied in the correct circumstances.