Résumé :
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WilliamWL Glenn and his group at Yale University developed electro ventilation to a method for ventilation of respiratory device-dependent patients, “Diaphragm Pacing”(DP) [JAMA1968;203 :1033-7]. Induction of electrical power and stimulation details through the intact skin to the implanted stimulator avoids skin penetrating cables (infection ports) and possible pain and burns due to surface electrodes. Carousel Stimulation and Four-pole Sequential Phrenic Nerve Stimulation (PNS) [Med Biol Eng Comput1990;28(1) : 31-7] were developed from DP in order to avoid electrical fatigue. PNS shortens the conditioning period compared to diaphragm pacing. However, evidence has been absent for superiority of DP/PNS over Mechanical Ventilation (MV). During twenty years of patients with functional C2-tetraplegia 32 received a PNS, 32 remained on MV. Mean surviving time was 3.4 years with PNS and 3.6 years with MV, the trend, however, being in favour of PNS. Treatment of respiratory insufficiency after cervical SCI with a Phrenic Nerve Stimulator instead of Mechanical Ventilation significantly reduces upper airway infections, reduces costs for single use airway equipment, improves the quality of speech, obviously improves patients' quality of life, and probably reduces mortality and prolongs life. The benefits together pay off the higher primary investment with PNS during the first year after start of use of PNS [Spinal Cord2008;46(11) :738-42].
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