| Full text | |
| Author(s): |
Tedde, Miguel Lia
[1]
;
Onders, Raymond P.
[2]
;
Teixeira, Manoel Jacobsen
[3]
;
Lage, Silvia Gelas
;
Ballester, Gerson
[3]
;
Lersolino Brotto, Mario Wilson
[4]
;
Okumura, Erica Mie
[1]
;
Jatene, Fabio Biscegli
Total Authors: 8
|
| Affiliation: | [1] Univ Sao Paulo, Sch Med, Hosp Clin, Inst Heart, Inst Coracao InCor, Dept Thorac Surg, Sao Paulo - Brazil
[2] Case Western Reserve Univ, Sch Med, Univ Hosp, Case Med Ctr, Dept Minimally Invas Surg, Cleveland, OH - USA
[3] Univ Sao Paulo, Sch Med, Hosp Clin, LIM26, Lab Med Res 26, Dept Neurosurg, Sao Paulo - Brazil
[4] Univ Sao Paulo, Sch Med, Hosp Clin, Dept Neurol, Sao Paulo - Brazil
Total Affiliations: 4
|
| Document type: | Journal article |
| Source: | Jornal Brasileiro de Pneumologia; v. 38, n. 5, p. 566-572, SEP-OCT 2012. |
| Web of Science Citations: | 10 |
| Abstract | |
OBJECTIVE: Patients with high cervical spinal cord injury are usually dependent on mechanical ventilation support, which, albeit life saving, is associated with complications and decreased life expectancy because of respiratory infections. Diaphragm pacing stimulation (DPS), sometimes referred to as electric ventilation, induces inhalation by stimulating the inspiratory muscles. Our objective was to highlight the indications for and some aspects of the surgical technique employed in the laparoscopic insertion of the DPS electrodes, as well as to describe five cases of tetraplegic patients submitted to the technique. METHODS: Patient selection involved transcutaneous phrenic nerve studies in order to determine whether the phrenic nerves were preserved. The surgical approach was traditional laparoscopy, with four ports. The initial step was electrical mapping in order to locate the "motor points" (the points at which stimulation would cause maximal contraction of the diaphragm). If the diaphragm mapping was successful, four electrodes were implanted into the abdominal surface of the diaphragm, two on each side, to stimulate the branches of the phrenic nerve. RESULTS: Of the five patients, three could breathe using DPS alone for more than 24 h, one could do so for more than 6 h, and one could not do so at all. CONCLUSIONS: Although a longer follow-up period is needed in order to reach definitive conclusions, the initial results have been promising. At this writing, most of our patients have been able to remain ventilator-free for long periods of time. (AU) | |