Journal article
Diaphragmatic reinnervation in ventilator-dependent patients with cervical spinal cord injury and concomitant phrenic nerve lesions using simultaneous nerve transfers and implantable neurostimulators
Journal of reconstructive microsurgery, v 31(5), pp 391-395
01 Jun 2015
PMID: 25868155
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Patients who are ventilator dependent as a result of combined cervical spinal cord injury and phrenic nerve lesions are generally considered to be unsuitable candidates for diaphragmatic pacing due to loss of phrenic nerve integrity and denervation of the diaphragm. There is limited data regarding efficacy of simultaneous nerve transfers and diaphragmatic pacemakers in the treatment of this patient population.
A retrospective review was conducted of 14 consecutive patients with combined lesions of the cervical spinal cord and phrenic nerves, and with complete ventilator dependence, who were treated with simultaneous microsurgical nerve transfer and implantation of diaphragmatic pacemakers. Parameters of interest included time to recovery of diaphragm electromyographic activity, average time pacing without the ventilator, and percent reduction in ventilator dependence.
Recovery of diaphragm electromyographic activity was demonstrated in 13 of 14 (93%) patients. Eight of these 13 (62%) patients achieved sustainable periods (> 1 h/d) of ventilator weaning (mean = 10 h/d [n = 8]). Two patients recovered voluntary control of diaphragmatic activity and regained the capacity for spontaneous respiration. The one patient who did not exhibit diaphragmatic reinnervation remains within 12 months of initial treatment. Surgical intervention resulted in a 25% reduction (p < 0.05) in ventilator dependency.
We have demonstrated that simultaneous nerve transfers and pacemaker implantation can result in reinnervation of the diaphragm and lead to successful ventilator weaning. Our favorable outcomes support consideration of this surgical method for appropriate patients who would otherwise have no alternative therapy to achieve sustained periods of ventilator independence.
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Details
- Title
- Diaphragmatic reinnervation in ventilator-dependent patients with cervical spinal cord injury and concomitant phrenic nerve lesions using simultaneous nerve transfers and implantable neurostimulators
- Creators
- Matthew R Kaufman - Jersey Shore University Medical CenterAndrew I Elkwood - Institute for Advanced ReconstructionFarid Aboharb - Institute for Advanced ReconstructionJohn Cece - Institute for Advanced ReconstructionDavid Brown - EdisonKameron Rezzadeh - Olive View-UCLA Medical CenterReza Jarrahy - Olive View-UCLA Medical Center
- Publication Details
- Journal of reconstructive microsurgery, v 31(5), pp 391-395
- Publisher
- Thieme
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000354755500010
- Scopus ID
- 2-s2.0-84929948040
- Other Identifier
- 991021930906404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery