Journal article
Treatment for bilateral diaphragmatic dysfunction using phrenic nerve reconstruction and diaphragm pacemakers
Interactive cardiovascular and thoracic surgery, v 32(5), pp 753-760
10 May 2021
PMID: 33432336
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
OBJECTIVES: Bilateral diaphragmatic dysfunction results in severe dyspnoea, usually requiring oxygen therapy and nocturnal ventilatory support. Although treatment options are limited, phrenic nerve reconstruction (PR) offers the opportunity to restore functional activity. This study aims to evaluate combination treatment with PR and placement of a diaphragm pacemaker (DP) compared to DP placement alone in patients with bilateral diaphragmatic dysfunction.
METHODS: Patients with bilateral diaphragmatic dysfunction were prospectively enrolled in the following treatment algorithm: Unilateral PR was performed on the more severely impacted side with bilateral DP implantation. Motor amplitudes, ultrasound measurements of diaphragm thickness, maximal inspiratory pressure, forced expiratory volume, forced vital capacity and subjective patient-reported outcomes were obtained for retrospective analysis following completion of the prospective database.
RESULTS: Fourteen male patients with bilateral diaphragmatic dysfunction confirmed on chest fluoroscopy and electrodiagnostic testing were included. All 14 patients required nocturnal ventilator support, and 8/14 (57.1%) were oxygen-dependent. All patients reported subjective improvement, and all 8 oxygen-dependent patients were able to discontinue oxygen therapy following treatment. Improvements in maximal inspiratory pressure, forced vital capacity and forced expiratory volume were 68%, 47% and 53%, respectively. There was an average improvement of 180% in motor amplitude and a 50% increase in muscle thickness. Comparison of motor amplitude changes revealed significantly greater functional recovery on the PR + DP side.
CONCLUSIONS: PR and simultaneous implantation of a DP may restore functional activity and alleviate symptoms in patients with bilateral diaphragmatic dysfunction. PR plus diaphragm pacing appear to result in greater functional muscle recovery than pacing alone.
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Details
- Title
- Treatment for bilateral diaphragmatic dysfunction using phrenic nerve reconstruction and diaphragm pacemakers
- Creators
- Matthew R. Kaufman - Institute for Advanced ReconstructionThomas Bauer - Jersey Shore University Medical CenterRaymond P. Onders - University Hospitals of ClevelandDavid P. Brown - John F. Kennedy Medical CenterEric I. Chang - Institute for Advanced ReconstructionKristie Rossi - Institute for Advanced ReconstructionAndrew I. Elkwood - Institute for Advanced ReconstructionEthan Paulin - Monmouth Medical CenterReza Jarrahy - Olive View-UCLA Medical Center
- Publication Details
- Interactive cardiovascular and thoracic surgery, v 32(5), pp 753-760
- Publisher
- Oxford Univ Press
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000661385100011
- Scopus ID
- 2-s2.0-85106540458
- Other Identifier
- 991021930435104721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery