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Other Applications of Diaphragm Ultrasound: Trauma, Malignancies, Ultrasound-Guided Procedures
Published in Massimo Zambon, Ultrasound of the Diaphragm and the Respiratory Muscles, 2022
Annia Schreiber, Cristian Deana, Luigi Vetrugno, Massimo Zambon
The structure, activity, and function of the diaphragm after SCI may be subject to change, either in accordance with the natural history of the spine injury, or as a consequence of interventions, such as respiratory muscle training techniques or diaphragm pacing aimed at improving respiratory function. Monitoring these changes by means of US, as done in mechanically ventilated ICU patients with no SCI (23–25), may allow the clinician to assess readiness to wean and predict weaning outcomes; once again, further trials conducted in this specific patient population are needed to confirm this hypothesis.
Congenital Central Hypoventilation Syndrome
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
CCHS is a rare disorder in young children in which the main manifestations are alveolar hypoventilation and autonomic dysregulation. As CCHS patients do not outgrow the disorder, their continuing survival with a good quality of life depends largely on the adequacy of ventilatory support [28,29]. Therefore, treatment options for CCHS include mechanical ventilation (e.g., positive pressure ventilation [PPV] via tracheostomy, noninvasive positive pressure ventilation [NIPPV], and diaphragm pacing [DP] to compensate for the altered/absent ventilatory responses to hypoxemia and hypercarbia), surgery and chemotherapy (for neuroblastomas), and cardiac pacemaker (for cardiac problems such as asystoles) [24,30–36].
Life Care Planning for Spinal Cord Injury
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
David J. Altman, Dan M. Bagwell
Chronic ventilation may become necessary to sustain life for those with global alveolar hypoventilation, particularly with vital capacities that are less than 5 to 10 mL/kg. There are a variety of devices that are employed to assist individuals with respiratory function. These include ventilation assist machines such as continuous positive airway pressure (CPAP) and biphasic positive airway pressure (BiPAP), which can improve oxygenation and prevent hypercarbia. Phrenic nerve pacing (diaphragm pacing) is another option that electrically stimulates the diaphragm to produce more physiologic respirations. Phrenic nerve pacing provides many ventilator-dependent tetraplegics with freedom from total dependence upon mechanical ventilation. Even though many individuals with phrenic nerve pacing will still require periods of ventilator assistance throughout the day and night, the risk of death is diminished in the event of mechanical failure of the ventilator and affords time for backup measures to be put into place.
Prospective analysis of a surgical algorithm to achieve ventilator weaning in cervical tetraplegia
Published in The Journal of Spinal Cord Medicine, 2022
Matthew R. Kaufman, Thomas Bauer, Stuart Campbell, Kristie Rossi, Andrew Elkwood, Reza Jarrahy
Diaphragm pacemakers have been used effectively since the 1970s in ventilator dependency associated with high spinal cord injury, achieving 80% or greater rates of weaning.10,11 A recent report supports diaphragm pacing in the acute setting after spinal cord injury to promote weaning in patients with a poor prognosis, as well as to shorten the time to weaning even in those that would otherwise achieve this over a longer time period.12 Requirements for successful application of a diaphragm pacemaker include: phrenic nerve integrity, diaphragm contractility, motivated patient and caregiver, preserved patient cognition, and absence of active respiratory infection.13 The benefits of successful weaning to a diaphragm pacemaker have been clearly elucidated in prior reports.3,5–7,14,15 Patients exhibit reductions in respiratory morbidity, improved quality of life, ease of speaking and eating, and are able to reduce their health care costs.
Section 11: Central hypoventilation, congenital and acquired
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2018
Theo J. Moraes, Ian MacLusky, David Zielinski, Reshma Amin
Phrenic nerve stimulation/diaphragm pacing is a potential option for CCHS.6,10,28–32 This form of support is best suited to older patients who require more than just nocturnal support but who would benefit from the freedom of not having a ventilator attached during the day. Pacing allows this mobility by triggering respiratory activity without the need for positive pressure ventilation. Patients usually require a tracheostomy to prevent upper airway obstruction caused by the absence of laryngeal and pharyngeal dilator muscle activation during paced breaths.32,38 However, decannulation is feasible. In addition, patients require bilateral phrenic nerve pacing, as opposed to unilateral, to ensure adequate ventilation, given the compliant chest wall and children’s higher metabolic rates.32 Diaphragm pacing is usually performed up to 12 hours a day in the pediatric population34 in order to reduce the risk of phrenic nerve damage secondary to traction as well as nerve burn out. Given the surgical and technical complexities required to achieve optimal ventilation while minimizing risks, this form of support requires a center with experience in diaphragm pacing. Currently there are only 3 centers in Canada that follow pediatric patients with diaphragm pacing: McGill (Montreal), McMaster (Hamilton) and BC Children’s Hospital (Vancouver).