Résumé :
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Introduction : For tetraplegics with chronic respiratory insufficiency, electrically induced diaphragm pacing is an alternative to long-term mechanical ventilation. This report summarizes a single site experience. Design : Prospective study of the Diaphragm Pacing Stimulation (DPS) System for electrical activation of the diaphragm for ventilatory assist in tetraplegics from March 2000 to January 2009. Participants/methods : Patients underwent laparoscopic diaphragm motor point mapping with electrode implantations. Stimulus/output characteristics of each electrode were determined and diaphragm conditioning initiated. Patients were progressively weaned at home from their ventilator as the diaphragm strengthened. Results : A total of 47 patients were implanted with failure only in the second patient, due to a false positive phrenic nerve study. There was no peri-operative mortality. Age ranged from 10 to 74 years old. Time from injury to implantation averaged 5.6 years (0.3 to 26). 100% of the successfully implanted had DPS tidal volumes above 5-7cc/Kg for 4 or more continuous hours. More than 50% were able to utilize DPS for continuous 24 hour ventilation. With over 100 cumulative years of follow-up there have been no internal electrode failures or patient deaths from pneumonia. In analyzing 7 patients with pre-existing cardiac pacemakers there was no cardiac or device to device interaction. Age and time from injury directly affects conditioning time to achieve ventilation with DPS with younger and more recently injured patients weaning from ventilation dependence faster. In long term analysis of patient and caregiver satisfaction (24 patients), over 60% report less secretions or suctioning, over 95% report greater freedom and independence, 100% would recommend to others and no patients have stopped utilization. Conclusion : DPS implantation is safe and can provide natural diaphragm ventilation. All ventilator dependent tetraplegics with intact phrenic nerves should be offered diaphragm pacing, not only for the decreased morbidity but most importantly for the patients' reported improved quality of life that DPS has provided.
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