Raymond P Onders1, Mary Jo Elmo, Anthony R Ignagni. 1. Department of Surgery, Case Medical Center of University Hospitals and Case Western Reserve University, Cleveland, Ohio, 44106-5047, USA. Raymond.onders@uhhospitals.org
Abstract
BACKGROUND: Children with cervical spinal cord injury and chronic respiratory insufficiency face the risks and stigma associated with mechanical ventilators. The Diaphragm Pacing Stimulation (DPS) System for electrical activation of the diaphragm is a minimally invasive alternative to mechanical ventilation. METHODS: Review of patients in a prospective Food and Drug Administration trial of the DPS System in individuals who were injured at age 18 years or younger. The procedure involved laparoscopic mapping to locate the diaphragm motor points with electrode implantation. Two weeks after surgery, stimulus/output characteristics of each electrode were determined to obtain an adequate tidal volume for ventilation. A home-based weaning protocol from the ventilator was used. RESULTS: Of 28 patients implanted with the DPS System, 10 had sustained cervical SCI as children or adolescents. Average age at injury was 13 years (range 1.5 to 17 y). Age at implantation ranged from 18 to 34 years. Length of time from injury to implantation averaged 9.7 years (0.8 to 19 y). All patients tolerated the implantation procedure. Four patients utilize DPS continuously (24/7), 4 patients pace daytime only, and 2 patients are still actively conditioning their diaphragms. Two patients required surgical correction of scoliosis prior to implantation. All patients prefer breathing with the DPS and would recommend it to others; 4 patients specifically identified that attending college or church without a ventilator eases their integration into society. CONCLUSIONS: The results show that the laparoscopic DPS system can be safely implanted in tetraplegics injured as children and used in a home-based environment to wean them off of mechanical ventilation.
BACKGROUND:Children with cervical spinal cord injury and chronic respiratory insufficiency face the risks and stigma associated with mechanical ventilators. The Diaphragm Pacing Stimulation (DPS) System for electrical activation of the diaphragm is a minimally invasive alternative to mechanical ventilation. METHODS: Review of patients in a prospective Food and Drug Administration trial of the DPS System in individuals who were injured at age 18 years or younger. The procedure involved laparoscopic mapping to locate the diaphragm motor points with electrode implantation. Two weeks after surgery, stimulus/output characteristics of each electrode were determined to obtain an adequate tidal volume for ventilation. A home-based weaning protocol from the ventilator was used. RESULTS: Of 28 patients implanted with the DPS System, 10 had sustained cervical SCI as children or adolescents. Average age at injury was 13 years (range 1.5 to 17 y). Age at implantation ranged from 18 to 34 years. Length of time from injury to implantation averaged 9.7 years (0.8 to 19 y). All patients tolerated the implantation procedure. Four patients utilize DPS continuously (24/7), 4 patients pace daytime only, and 2 patients are still actively conditioning their diaphragms. Two patients required surgical correction of scoliosis prior to implantation. All patients prefer breathing with the DPS and would recommend it to others; 4 patients specifically identified that attending college or church without a ventilator eases their integration into society. CONCLUSIONS: The results show that the laparoscopic DPS system can be safely implanted in tetraplegics injured as children and used in a home-based environment to wean them off of mechanical ventilation.
Authors: Anthony F DiMarco; Raymond P Onders; Krzysztof E Kowalski; Michael E Miller; Sandra Ferek; J Thomas Mortimer Journal: Am J Respir Crit Care Med Date: 2002-12-15 Impact factor: 21.405
Authors: Anthony F DiMarco; Raymond P Onders; Anthony Ignagni; Krzysztof E Kowalski; J Thomas Mortimer Journal: Chest Date: 2005-02 Impact factor: 9.410
Authors: Raymond P Onders; Michael F McGee; Jeffrey Marks; Amitabh Chak; Michael J Rosen; Anthony Ignagni; Ashley Faulx; Steve Schomisch; Jeffrey Ponsky Journal: Surg Endosc Date: 2007-02-16 Impact factor: 4.584
Authors: Gregoire Cosendai; Chloe de Balthasar; Anthony R Ignagni; Raymond P Onders; Kerry Bradley; Kate Purnell; J Thomas Mortimer; Ross Davis; Yitzhak Zilberman; Joe Schulman Journal: Neuromodulation Date: 2005-07
Authors: Kristiina M Hormigo; Lyandysha V Zholudeva; Victoria M Spruance; Vitaliy Marchenko; Marie-Pascale Cote; Stephane Vinit; Simon Giszter; Tatiana Bezdudnaya; Michael A Lane Journal: Exp Neurol Date: 2016-08-28 Impact factor: 5.330
Authors: Raymond P Onders; Maryjo Elmo; Saeid Khansarinia; Brock Bowman; John Yee; Jeremy Road; Barbara Bass; Brian Dunkin; Páll E Ingvarsson; Margrét Oddsdóttir Journal: Surg Endosc Date: 2008-12-06 Impact factor: 4.584
Authors: Ha Trang; Jean-François Brunet; Hermann Rohrer; Jorge Gallego; Jeanne Amiel; Tiziana Bachetti; Kenneth H Fischbeck; Thomas Similowski; Christian Straus; Isabella Ceccherini; Debra E Weese-Mayer; Matthias Frerick; Katarzyna Bieganowska; Linda Middleton; Francesco Morandi; Giancarlo Ottonello Journal: Orphanet J Rare Dis Date: 2014-12-05 Impact factor: 4.123