Phrenic Nerve Stimulation

Mr. LM and his family have searched the internet to learn about respiratory function in patients with tetraplegia. He is interested in phrenic nerve stimulation, and wonders if he is a candidate. He asks you about this technology.
What are the various types of phrenic nerve stimulation to trigger inspiratory muscle function and what is the evidence associated with each?
1.  Electrical stimulation options for the restoration of inspiratory muscle function in subjects with spinal cord injuries include bilateral phrenic nerve pacing, bilateral diaphragmatic pacing and combined intercostal muscle stimulation with unilateral phrenic pacing (Di Marco 2005; Figure 4).
2. There is some evidence that suggests a higher survival rate, as well asbetter power wheelchair management, phonation success, and patient satisfaction in phrenic paced subjects compared to mechanically ventilated subjects.
3. Phrenic nerve stimulation may be used as a long-term alternative to mechanical ventilation for subjects with injuries at C2 or above

For more information please see:Phrenic Nerve Stimulation for Respiratory Function Post SCI

Figure 4. Avery Breathing Pacemaker System, an FES system for respiratory muscles by phrenic nerve stimulation (courtesy of Avery Biomedical Devices, Commack, NY, USA).