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The diaphragm is primarily controlled by the phrenic nerve. Diaphragm pacing involves the stimulation of the phrenic nerve to restore diaphragm function, and ultimately independent respiratory control (Madden, 2016). In 2008 the Food and Drug Administration approved the use of the NeuRx Diaphragm Pacing System (DPS) for humanitarian-use for patients with SCI (Madden, 2016).

Table 9. Effect of Diaphragm Pacing on Respiration during Acute SCI

Author Year

Country

Research Design

PEDro

Sample Size

MethodsOutcomes
Kerwin et al. (2018)

United States

Case Control

N=101

Population: DPS Group, n=40: Mean age: 45 yr; Gender: male=29, female=11; Level of injury: C1-C4= 35%, C5-C7= 65%; Severity of injury: complete=88%, incomplete=12%. No DPS Group, n=61: Mean age: 39 yr; Gender: male=54, female=7; Level of injury: C1-C4=33%, C5-C7=67%; Severity of injury: complete= 82%, incomplete= 15%.

Intervention: Patients either underwent diaphragm pacing system implantation or did not.

Outcome Measures: Ventilator days, ventilator associated pneumonia.

Chronicity: Patient population defined as acute.

1.     There were no significant differences between groups in terms of the number of days spent on ventilators.

2.     There were no significant differences between groups in terms of the rates of ventilator associated pneumonia.

Discussion

To date only one case control study has examined diaphragm pacing during the acute SCI phase. Diaphragm pacing is one of the newer approved interventions for respiratory functions post SCI. In the recent study by Kerwin et al. (2018), diaphragm pacing was found to have no significant influence on the rates of ventilator associated pneumonia. However, it’s efficacy as an intervention for improving respiratory outcomes needs to be further examined as there were no significant effects of diaphragm pacing on the number of days spent on a ventilator. As only one respiratory outcome and one complication were examined in this sole study, more research needs to be conducted to make conclusions about the value of diaphragm pacing for acute SCI patients.

Conclusion

There is level 3 evidence (from one case control study; Kerwin et al., 2018) that diaphragm pacing may not increase the risk of ventilator associated pneumonia or reduce the number of ventilator days compared to no implantation for acute SCI patients.

  • Diaphragm pacing may not reduce the number of days spent on a ventilator, however it also does not appear to increase the risk of ventilator associated pneumonia in acute SCI patients.