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Diaphragm pacing

Thomas Breuer, Nima Hatam, Benjamin Grabiger, Gernot Marx, Bradley J Behnke, Joachim Weis, Ruedger Kopp, Ghislaine Gayan-Ramirez, Norbert Zoremba, Christian S Bruells
Perioperative necessity of deep sedation is inevitably associated with diaphragmatic inactivation. This study investigated 1) the feasibility of a new phrenic nerve stimulation method allowing early diaphragmatic activation even in deep sedation and, 2) metabolic changes within the diaphragm during mechanical ventilation compared to artificial activity. 12 piglets were separated into 2 groups. One group was mechanically ventilated for 12 hrs (CMV) and in the second group both phrenic nerves were stimulated via pacer wires inserted near the phrenic nerves to mimic spontaneous breathing (STIM)...
October 19, 2016: Scientific Reports
Jésus Gonzalez-Bermejo, Capucine Morélot-Panzini, Marie-Laure Tanguy, Vincent Meininger, Pierre-François Pradat, Timothée Lenglet, Gaëlle Bruneteau, Nadine Le Forestier, Philippe Couratier, Nathalie Guy, Claude Desnuelle, Hélène Prigent, Christophe Perrin, Valérie Attali, Catherine Fargeot, Marie-Cécile Nierat, Catherine Royer, Fabrice Ménégaux, François Salachas, Thomas Similowski
BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder associated with respiratory muscle weakness and respiratory failure. Non-invasive ventilation alleviates respiratory symptoms and prolongs life, but is a palliative intervention. Slowing the deterioration of diaphragm function before respiratory failure would be desirable. We aimed to assess whether early diaphragm pacing could slow down diaphragm deterioration and would therefore delay the need for non-invasive ventilation...
November 2016: Lancet Neurology
Giuseppe Morici, Monica Frinchi, Alessandro Pitruzzella, Valentina Di Liberto, Rosario Barone, Andrea Pace, Valentina Di Felice, Natale Belluardo, Francesco Cappello, Giuseppa Mudò, Maria R Bonsignore
In the mdx mice model of Duchenne Muscular Dystrophy (DMD), mild endurance exercise training positively affected limb skeletal muscles, whereas few and controversial data exist on the effects of training on the diaphragm. The diaphragm was examined in mdx (C57BL/10ScSn-Dmdmdx) and wild type (WT, C57BL/10ScSc) mice under sedentary conditions (mdx-SD, WT-SD) and during mild exercise training (mdx-EX, WT-EX). At baseline, and after 30 and 45 days (training: 5 d/wk for 6 weeks), diaphragm muscle morphology and Cx39 protein were assessed...
August 30, 2016: Journal of Cellular Physiology
Parikshit S Sharma, Santosh K Padala, J Jenkins Thompson, Sampath Gunda, Jayanthi N Koneru, Kenneth A Ellenbogen
INTRODUCTION: The diaphragmatic compound motor action potentials (CMAPs) have been used to predict and prevent phrenic nerve injury (PNI) during cryoballoon ablation of right pulmonary veins. We sought to assess factors that influence the amplitude of the surface CMAP recordings. METHODS AND RESULTS: We analyzed CMAPs from consecutive patients undergoing cryoballoon ablation for paroxysmal atrial fibrillation. CMAP recordings were obtained using ECG electrodes positioned in the "modified lead I" method while stimulating the right PN, until loss of capture (ascertained by palpation and fluoroscopy of the right hemi-diaphragm)...
August 25, 2016: Journal of Cardiovascular Electrophysiology
Steven C Reynolds, Ramasamy Meyyappan, Viral Thakkar, Bao D Tran, Marc-André Nolette, Gautam Sadarangani, Rodrigo A Sandoval, Laura Bruulsema, Brett Hannigan, Jason W Li, Elizabeth Rohrs, Jason Zurba, Joaquín Andrés Hoffer
Rationale Ventilator-induced Diaphragm Dysfunction is a significant contributor to weaning difficulty in ventilated critically ill patients. It has been hypothesized that electrically pacing the diaphragm during mechanical ventilation could reduce diaphragm dysfunction. Objectives We tested a novel, central line catheter-based, transvenous phrenic nerve pacing therapy for protecting the diaphragm in sedated and ventilated pigs. Methods Eighteen Yorkshire pigs were studied. Six pigs were sedated and mechanically ventilated for 2...
August 8, 2016: American Journal of Respiratory and Critical Care Medicine
Christopher J McDermott, Mike J Bradburn, Chin Maguire, Cindy L Cooper, Wendy O Baird, Susan K Baxter, Judith Cohen, Hannah Cantrill, Simon Dixon, Roger Ackroyd, Simon Baudouin, Andrew Bentley, Richard Berrisford, Stephen Bianchi, Stephen C Bourke, Roy Darlison, John Ealing, Mark Elliott, Patrick Fitzgerald, Simon Galloway, Hisham Hamdalla, C Oliver Hanemann, Philip Hughes, Ibrahim Imam, Dayalan Karat, Roger Leek, Nick Maynard, Richard W Orrell, Abeezar Sarela, John Stradling, Kevin Talbot, Lyn Taylor, Martin Turner, Anita K Simonds, Tim Williams, Wisia Wedzicha, Carolyn Young, Pamela J Shaw
BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease resulting in death, usually from respiratory failure, within 2-3 years of symptom onset. Non-invasive ventilation (NIV) is a treatment that when given to patients in respiratory failure leads to improved survival and quality of life. Diaphragm pacing (DP), using the NeuRx/4(®) diaphragm pacing system (DPS)™ (Synapse Biomedical, Oberlin, OH, USA), is a new technique that may offer additional or alternative benefits to patients with ALS who are in respiratory failure...
June 2016: Health Technology Assessment: HTA
Francoise Le Pimpec-Barthes, Antoine Legras, Alex Arame, Ciprian Pricopi, Jean-Claude Boucherie, Alain Badia, Capucine Morelot Panzini
Diaphragm pacing (DP) is an orphan surgical procedure that may be proposed in strictly selected ventilator-dependent patients to get an active diaphragm contraction. The goal is to wean from mechanical ventilation (MV) and restore permanent efficient breathing. The two validated indications, despite the lack of randomised control trials, concern patients with high-level spinal cord injuries (SCI) and central hypoventilation syndromes (CHS). To date, two different techniques exist. The first, intrathoracic diaphragm pacing (IT-DP), based on a radiofrequency method, in which the electrodes are directly placed around the phrenic nerve...
April 2016: Journal of Thoracic Disease
Iris A Perez, Sheila Kun, Thomas G Keens
No abstract text is available yet for this article.
April 15, 2016: American Journal of Respiratory and Critical Care Medicine
Nicholas J Silvestri, Gil I Wolfe, Mark Bromberg, David Lacomis
In this issue, we review clinical features associated with an elevated serum creatine kinase level found in a percentage of patients with amyotrophic lateral sclerosis (ALS). The treatment of ALS remains problematic, and issues with offerings on the internet for unregulated stem cell treatment and the movement for right-to-try experimental drugs are discussed. The last What's in the Literature? discussed information about recording from stimulating electrodes implanted in the diaphragm of ALS patients, and this issue discusses the results of a randomized trial using diaphragm pacing...
March 2016: Journal of Clinical Neuromuscular Disease
Luke E Hodgson, Patrick B Murphy
Home mechanical ventilation (HMV) is an increasingly common intervention and is initiated for a range of pathological processes, including neuromuscular disease (NMD), chronic obstructive pulmonary disease (COPD) and obesity related respiratory failure. There have been important recent data published in this area, which helps to guide practice by indicating which populations may benefit from this intervention and the optimum method of setting up and controlling sleep disordered breathing. Recent superficially conflicting data has been published regarding HMV in COPD, with a trial in post-exacerbation patients suggesting no benefit, but in stable chronic hypercapnic patients suggesting a clear and sustained mortality benefit...
February 2016: Journal of Thoracic Disease
Barbara K Smith, David D Fuller, A Daniel Martin, Lawrence Lottenberg, Saleem Islam, Lee Ann Lawson, Raymond P Onders, Barry J Byrne
BACKGROUND AND PURPOSE: Pompe disease is an inherited disorder notable for severe, progressive ventilatory compromise. Although ventilatory failure has been attributed to myofiber dysfunction secondary to diaphragmatic glycogen accumulation, neural involvement of the phrenic motor system is also a prominent feature. Direct diaphragm pacing supplements respiratory function in other disorders of the phrenic motor system. Accordingly, it is hypothesized that augmented neuromuscular activity via diaphragm pacing would promote weaning from mechanical ventilation in patients with Pompe disease who are unresponsive to conventional, muscle-directed treatments...
May 2016: Physical Therapy
Bhavin Garara, Alasdair Wood, Hani J Marcus, Kevin Tsang, Mark H Wilson, Mansoor Khan
BACKGROUND: Intramuscular diaphragmatic stimulation using an abdominal laparoscopic approach has been proposed as a safer alternative to traditional phrenic nerve stimulation. It has also been suggested that early implementation of diaphragmatic pacing may prevent diaphragm atrophy and lead to earlier ventilator independence. The aim of this study was therefore to systematically review the safety and effectiveness of intramuscular diaphragmatic stimulators in the treatment of patients with traumatic high cervical injuries resulting in long-term ventilator dependence, with particular emphasis on the affect of timing of insertion of such stimulators...
March 2016: Injury
Kaori Irahara, Tomomi Ogata, Hiroshi Ozawa, Ushio Otaki, Keiichi Yamamoto, Takehiro Ishizuka, Kiyoshi Arimoto, Satoshi Kimiya, Koichi Arakawa, Kazuhiro Muramatsu
OBJECTIVE: To evaluate the psychological development of patients with congenital central hypoventilation syndrome (CCHS). METHODS: We performed a questionnaire-based survey of 17 patients with CCHS aged over 7 years and assessed their clinical course, respiratory management, and psychological development. RESULTS: CCHS was present at birth in 15 patients, of which eight presented with respiratory failure with a low Apgar score. Twelve patients required mechanical ventilation with intubation, and five received mask ventilation...
September 2015: No to Hattatsu. Brain and Development
Emanuela Marcelli, Laura Cercenelli
We developed a cardiorespiratory mechanical simulator (CRMS), a system able to reproduce both the cardiac and respiratory movements, intended to be used for in vitro testing of impedance minute ventilation (iMV) sensors in cardiac pacemakers. The simulator consists of two actuators anchored to a human thorax model and a software interface to control the actuators and to acquire/process impedance signals. The actuators can be driven separately or simultaneously to reproduce the cardiac longitudinal shortening at a programmable heart rate and the diaphragm displacement at a programmable respiratory rate (RR)...
March 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Dilcan Kotan, Kamil Kaymak, Aslı Aksoy Gündogdu
The diaphragm pacing system (DPS) is a life quality improving operation in amyotrophic lateral sclerosis (ALS) patients who need mechanical ventilation or have chronic respiratory insufficiency. This procedure is gaining in popularity, and the number of centers implanting diaphragm pacing systems (DPS) is increasing. DPS delays the need for a ventilation machine in the early stages of Amyotrophic lateral sclerosis (ALS) disease. In this case study, we present a young female ALS patient. A DPS was implanted after respiratory insufficiency began...
August 10, 2016: Journal of Back and Musculoskeletal Rehabilitation
Heather Wood
No abstract text is available yet for this article.
September 2015: Nature Reviews. Neurology
Lila Layachi, Marjolaine Georges, Jésus Gonzalez-Bermejo, Anne-Laure Brun, Thomas Similowski, Capucine Morélot-Panzini
Diaphragm pacing allows certain quadriplegic patients to be weaned from mechanical ventilation. Pacing failure can result from device dysfunction, neurotransmission failure, or degraded lung mechanics (such as atelectasis). We report two cases where progressive pacing failure was attributed to deteriorated chest wall mechanics. The first patient suffered from cervical spinal cord injury at age 45, was implanted with a phrenic stimulator (intrathoracic), successfully weaned from ventilation, and permanently paced for 7 years...
2015: Respiratory Medicine Case Reports
Christopher J McDermott, Mike J Bradburn, Chin Maguire, Cindy L Cooper, Wendy O Baird, Susan K Baxter, Stephen C Bourke, Ibrahim Imam, Andrew Bentley, John Ealing, Mark Elliott, C Oliver Hanemann, Philip Hughes, Richard W Orrell, Pamela J Shaw, Kevin Talbot, Tim Williams, Roger Ackroyd, Richard Berrisford, Simon Galloway, Dayalan Karat, Nick Maynard, Abeezar Sarela, Anita K Simonds, Lyn Taylor, Roger Leek, Roy Darlison, Nigel Leigh, Michael Dewey, Aleksandar Radunovic
BACKGROUND: Non-invasive ventilation is part of the standard of care for treatment of respiratory failure in patients with amyotrophic lateral sclerosis (ALS). The NeuRx RA/4 Diaphragm Pacing System has received Humanitarian Device Exemption approval from the US Food and Drug Administration for treatment of respiratory failure in patients with ALS. We aimed to establish the safety and efficacy of diaphragm pacing with this system in patients with respiratory muscle weakness due to ALS...
September 2015: Lancet Neurology
Hiroshi Mitsumoto
No abstract text is available yet for this article.
September 2015: Lancet Neurology
Sarah E Stromberg, Matthew E Russell, Charles R Carlson
BACKGROUND: Motion sickness is an unpleasant physiological state that may be controlled via nonpharmacological methods. Controlled breathing has been shown to maximize parasympathetic nervous system (PNS) tone and may have the ability to decrease motion sickness symptoms. METHODS: The effects of slow diaphragmatic breathing (DB) in a motion sickness-inducing environment were examined within motion sickness susceptible individuals. Subjects (N = 43) were assigned randomly to either an experimental group trained in slow DB or a control group breathing naturally at a normal pace...
May 2015: Aerospace Medicine and Human Performance
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