Diaphragm pacing as an adjunct in respiratory insufficiency.

Most neurosurgical patients with permanent partial or complete respiratory insufficiency are managed with a mechanical ventilator and tracheostomy. This method presents many medical, technical, emotional, and social problems. A case is presented that illustrates the potential usefulness of electrical stimulation of the phrenic nerve ("diaphragm pacing") as an alternate method of therapy for respiratory insufficiency. This paper outlines the indications for, methods of, and problems with such a system and is intended to make its availability more widely appreciated among neurosurgeons.