• Miguel L Tedde, Paulo Vasconcelos Filho, Ludhmila Abrahão Hajjar, Juliano Pinheiro de Almeida, Gustavo Fagundes Flora, Erica Mie Okumura, Eduardo A Osawa, Julia Tizue Fukushima, Manoel Jacobsen Teixeira, Filomena Regina Barbosa Gomes Galas, Fabio Biscegli Jatene, and José Otávio Costa Auler.
• Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Thoracic Surgery Department, São Paulo/SP, Brazil. tedde@usp.br
• Clinics (Sao Paulo). 2012 Nov 1;67(11):1265-9.

ObjectiveThe standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker.MethodsFive patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384.ResultsThe diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day.ConclusionsThe implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.

28 keywords...

hide…