Abstract
Symptoms of unilateral diaphragmatic paralysis can range from sleep-related symptoms to exert ional dyspnea or orthopnea. At times unilateral diaphragm paralysis is found on routine chest radiograph alone when an elevated hemidiaphragm is seen. Ventilatory failure will usually only result if there is bilateral diaphragmatic involvement. When diaphragmatic paralysis is suspected, confirmatory testing is done by inspiratory fluoroscopy (sniff test) and electromyography of the phrenic nerve. To determine if the conduction path of the phrenic nerve is intact from the cervical region to the diaphragm, the key test is fluoroscopic visualization of the diaphragm with transcutaneous stimulation of the phrenic nerve in the neck. If the diaphragm moves during stimulation then the phrenic nerve is intact, but there is a disruption of the signal pathway from the respiratory center in the brain to the phrenic nerve causing the diaphragm not to function.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Oo T, Watt JW, Soni BM, Sett PK. Delayed diaphragm recovery in 12 patients after high cervical spinal cord injury. A retrospective review of the diaphragm status of 107 patients ventilated after acute spinal cord injury. Spinal Cord 1999;37:117–122.
Glenn WW, Holcomb WG, Hogan J, et al. Diaphragm pacing by radiofrequency transmission in the treatment of chronic ventilatory insufficiency. Present status. J Thorac Cardiovasc Surg 1973;66:505–520.
Morgan JA, Ginsburg ME, Sonett JR, et al. Advanced thoracoscopic procedures are facilitated by computer-aided robotic technology. Eur J Cardiothorac Surg 2003;23:883–887; discussion 887.
Shaul DB, Danielson PD, McComb JG, Keens TG. Thoracoscopic placement of phrenic nerve electrodes for diaphragmatic pacing in children. J Pediatr Surg 2002;37:974–978; discussion 978.
DiMarco AF, Onders RP, Kowalski KE, Miller ME, Ferek S, Mortimer JT. Phrenic nerve pacing in a tetraplegic patient via intramuscular diaphragm electrodes. Am J Respir Crit Care Med 2002;166:1604–1606.
Onders RP, Aiyar H, Mortimer JT. Characterization of the human diaphragm muscle with respect to the phrenic nerve motor points for diaphragmatic pacing. Am Surg 2004;70:241–247; discussion 247.
Aiyar H, Stellato TA, Onders RP, Mortimer JT. Laparoscopic implant instrument for the placement of intramuscular electrodes in the diaphragm. IEEE Trans Rehabil Eng 1999;7:360–371.
Krieger AJ, Danetz I, Wu SZ, Spatola M, Sapru HN. Electrophrenic respiration following anastomosis of phrenic with branchial nerve in the cat. J Neurosurg 1983;59:262–267.
Dobelle WH, D’Angelo MS, Goetz BF, et al. 200 cases with a new breathing pacemaker dispel myths about diaphragm pacing. ASAIO J 1994;40:M244–M252.
Elefteriades JA, Quin JA, Hogan JF, et al. Longterm follow-up of pacing of the conditioned diaphragm in quadriplegia. Pacing Clin Electrophysiol 2002;25:897–906.
Tibballs J. Diaphragmatic pacing: an alternative to long-term mechanical ventilation. Anaesth Intensive Care 1991;19:597–601.
Creasey G, Elefteriades J, DiMarco A, et al. Electrical stimulation to restore respiration. J Rehabil Res Dev 1996;33:123–132.
DiMarco A. Diaphragm pacing in patients with spinal cord injury. Topics Spinal Cord Rehabil 1999;5:6–20.
Glenn WW, Phelps ML, Elefteriades JA, Dentz B, Hogan JF. Twenty years of experience in phrenic nerve stimulation to pace the diaphragm. Pacing Clin Electrophysiol 1986;9:780–784.
Carter RE, Donovan WH, Halstead L, Wilkerson MA. Comparative study of electrophrenic nerve stimulation and mechanical ventilatory support in traumatic spinal cord injury. Paraplegia 1987;25:86–91.
Weese-Mayer DE, Silvestri JM, Kenny AS, et al. Diaphragm pacing with a quadripolar phrenic nerve electrode: an international study. Pacing Clin Electrophysiol 1996;19:1311–1319.
Elefteriades JA, Quin JA. Diaphragm pacing. Chest Surg Clin North Am 1998;8:331–357.
Elefteriades JA, Hogan JF, Handler A, Loke JS. Long-term follow-up of bilateral pacing of the diaphragm in quadriplegia. N Engl J Med 1992;326:1433–1434.
DiMarco AF, Onders RP, Ignagni A, Kowalski KE, Mortimer JT. Phrenic nerve pacing via intramuscular diaphragm electrodes in tetraplegic subjects. Chest 2005;127:671–678.
Onders RP, Dimarco AF, Ignagni AR, Mortimer JT. The Learning curve for investigational surgery: lessons learned from laparoscopic diaphragm pacing for chronic ventilator dependence. Surg Endosc 2005;19(5):633–637.
Cosendai G, de Balthasar C, Ignagni AR, et al. A preliminary feasibility study of different implantable pulse generators technologies for diaphragm pacing system. Neuromodulation 2005;8:203–211.
DiMarco AF, Supinski GS, Petro JA, Takaoka Y. Evaluation of intercostal pacing to provide artificial ventilation in quadriplegics. Am J Respir Crit Care Med 1994;150:934–940.
DiMarco AF, Takaoka Y, Kowalski KE. Combined intercostal and diaphragm pacing to provide artificial ventilation in patients with tetraplegia. Arch Phys Med Rehabil 2005;86:1200–1207.
Krieger AJ, Gropper MR, Adler RJ. Electrophrenic respiration after intercostal to phrenic nerve anastomosis in a patient with anterior spinal artery syndrome: technical case report. Neurosurgery 1994;35:760–763; discussion 763–764.
Krieger AJ. Electrophrenic respiration after intercostals to phrenic nerve anastomosis in a patient with anterior spinal artery syndrome: technical case report [letter]. Neurosurgery 1995;37:553.
Krieger LM, Krieger AJ. The intercostal to phrenic nerve transfer: an effective means of reanimating the diaphragm in patients with high cervical spine injury. Plast Reconstr Surg 2000;105:1255–1261.
Fodstad H. Electrophrenic respiration after intercostals to phrenic nerve anastomosis on a patient with anterior spinal artery syndrome: technical case report. Neurosurgery 1996;38:420.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Springer-Verlag London Limited
About this chapter
Cite this chapter
Onders, R.P. (2007). Pacing for Unilateral Diaphragm Paralysis. In: Ferguson, M.K. (eds) Difficult Decisions in Thoracic Surgery. Springer, London. https://doi.org/10.1007/978-1-84628-474-8_45
Download citation
DOI: https://doi.org/10.1007/978-1-84628-474-8_45
Publisher Name: Springer, London
Print ISBN: 978-1-84628-384-0
Online ISBN: 978-1-84628-474-8
eBook Packages: MedicineMedicine (R0)