RT Book, Section
A1 Ducko, Christopher T.
A2 Sugarbaker, David J.
A2 Bueno, Raphael
A2 Burt, Bryan M.
A2 Groth, Shawn S.
A2 Loor, Gabriel
A2 Wolf, Andrea S.
A2 Williams, Marcia
A2 Adams, Ann
SR Print(0)
ID 1170415989
T1 Diaphragm Pacing
T2 Sugarbaker’s Adult Chest Surgery, 3e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260026931
LK accesssurgery.mhmedical.com/content.aspx?aid=1170415989
RD 2024/04/25
AB The  technique  of  applying  electrical  stimulation  to  the  phrenic  nerve  to  induce  diaphragm  pacing  was  first  described  by  Cavallo  in  1777.1  Early  proponents  used  this  technique  for  a  variety  of  conditions  associated  with  impaired  respiration,  including  asphyxia  (Hufeland,  1783),  cholera  (Duchenne,  1849),  apnea  (Israel,  1927),  and  polio  (Sarnoff,  1950).2  Diaphragm  pacing  was  introduced  into  contemporary  thoracic  surgical  practice  in  the  1970s  by  Glenn,  who  pioneered  its  application  in  patients  with  central  apnea  and  quadriplegia.2–4  With  the  standard  pacing  devices,  the  electrical  stimulus  is  applied  at  the  phrenic  nerve,  as  originally  described.  However,  a  newer  approach  applies  the  stimulus  directly  into  the  muscle  at  the  phrenic  nerve  motor  point  for  more  direct  control.5  The  primary  conditions  amenable  to  pacing  are  high  cervical  spinal  cord  injuries  (i.e.,  C3–C5)  and  congenital  or  acquired  central  hypoventilation  syndrome.  Onders  et  al.  have  extended  pacing  via  the  motor  point  technique  to  other  populations,  including  patients  with  the  progressive  neuromuscular  degenerative  disorder  amyotrophic  lateral  sclerosis  (ALS),  and  other  more  transient  problems  such  as  intensive  care  unit  patients  who  demonstrate  difficulty  weaning  from  mechanical  ventilation.6,7