Diaphragm Pacing
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).
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Author Year; Country |
Methods | Outcome |
|---|---|---|
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Kerwin et al. (2018); United States |
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%. |
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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.
