Matthew R Kaufman1,2,3, Thomas Bauer2,4, Raymond P Onders5, David P Brown6, Eric I Chang1,2, Kristie Rossi1, Andrew I Elkwood1,2, Ethan Paulin7, Reza Jarrahy3. 1. The Institute for Advanced Reconstruction, Shrewsbury, NJ, USA. 2. Center for Paralysis and Reconstructive Nerve Surgery, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune, NJ, USA. 3. Division of Plastic and Reconstructive Surgery, David Geffen UCLA Medical Center, Los Angeles, CA, USA. 4. Department of Thoracic and Cardiac Surgery, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune, NJ, USA. 5. Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. 6. Department of Physical Medicine and Rehabilitation, JFK Medical Center, Edison, NJ, USA. 7. Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA.
Abstract
OBJECTIVES: Bilateral diaphragmatic dysfunction results in severe dyspnoea, usually requiring oxygen therapy and nocturnal ventilatory support. Although treatment options are limited, phrenic nerve reconstruction (PR) offers the opportunity to restore functional activity. This study aims to evaluate combination treatment with PR and placement of a diaphragm pacemaker (DP) compared to DP placement alone in patients with bilateral diaphragmatic dysfunction. METHODS: Patients with bilateral diaphragmatic dysfunction were prospectively enrolled in the following treatment algorithm: Unilateral PR was performed on the more severely impacted side with bilateral DP implantation. Motor amplitudes, ultrasound measurements of diaphragm thickness, maximal inspiratory pressure, forced expiratory volume, forced vital capacity and subjective patient-reported outcomes were obtained for retrospective analysis following completion of the prospective database. RESULTS: Fourteen male patients with bilateral diaphragmatic dysfunction confirmed on chest fluoroscopy and electrodiagnostic testing were included. All 14 patients required nocturnal ventilator support, and 8/14 (57.1%) were oxygen-dependent. All patients reported subjective improvement, and all 8 oxygen-dependent patients were able to discontinue oxygen therapy following treatment. Improvements in maximal inspiratory pressure, forced vital capacity and forced expiratory volume were 68%, 47% and 53%, respectively. There was an average improvement of 180% in motor amplitude and a 50% increase in muscle thickness. Comparison of motor amplitude changes revealed significantly greater functional recovery on the PR + DP side. CONCLUSIONS: PR and simultaneous implantation of a DP may restore functional activity and alleviate symptoms in patients with bilateral diaphragmatic dysfunction. PR plus diaphragm pacing appear to result in greater functional muscle recovery than pacing alone.
OBJECTIVES: Bilateral diaphragmatic dysfunction results in severe dyspnoea, usually requiring oxygen therapy and nocturnal ventilatory support. Although treatment options are limited, phrenic nerve reconstruction (PR) offers the opportunity to restore functional activity. This study aims to evaluate combination treatment with PR and placement of a diaphragm pacemaker (DP) compared to DP placement alone in patients with bilateral diaphragmatic dysfunction. METHODS: Patients with bilateral diaphragmatic dysfunction were prospectively enrolled in the following treatment algorithm: Unilateral PR was performed on the more severely impacted side with bilateral DP implantation. Motor amplitudes, ultrasound measurements of diaphragm thickness, maximal inspiratory pressure, forced expiratory volume, forced vital capacity and subjective patient-reported outcomes were obtained for retrospective analysis following completion of the prospective database. RESULTS: Fourteen male patients with bilateral diaphragmatic dysfunction confirmed on chest fluoroscopy and electrodiagnostic testing were included. All 14 patients required nocturnal ventilator support, and 8/14 (57.1%) were oxygen-dependent. All patients reported subjective improvement, and all 8 oxygen-dependent patients were able to discontinue oxygen therapy following treatment. Improvements in maximal inspiratory pressure, forced vital capacity and forced expiratory volume were 68%, 47% and 53%, respectively. There was an average improvement of 180% in motor amplitude and a 50% increase in muscle thickness. Comparison of motor amplitude changes revealed significantly greater functional recovery on the PR + DP side. CONCLUSIONS: PR and simultaneous implantation of a DP may restore functional activity and alleviate symptoms in patients with bilateral diaphragmatic dysfunction. PR plus diaphragm pacing appear to result in greater functional muscle recovery than pacing alone.
Authors: Matthew R Kaufman; Andrew I Elkwood; Michael I Rose; Tushar Patel; Russell Ashinoff; Ryan Fields; David Brown Journal: Anesthesiology Date: 2013-08 Impact factor: 7.892
Authors: Matthew R Kaufman; Andrew I Elkwood; Michael I Rose; Tushar Patel; Russell Ashinoff; Adam Saad; Robert Caccavale; Jean-Philippe Bocage; Jeffrey Cole; Aida Soriano; Ed Fein Journal: Chest Date: 2011-02-24 Impact factor: 9.410
Authors: Matthew R Kaufman; Andrew I Elkwood; Farid Aboharb; John Cece; David Brown; Kameron Rezzadeh; Reza Jarrahy Journal: J Reconstr Microsurg Date: 2015-04-13 Impact factor: 2.873
Authors: Matthew R Kaufman; Andrew I Elkwood; Alan R Colicchio; John CeCe; Reza Jarrahy; Lourens J Willekes; Michael I Rose; David Brown Journal: Ann Thorac Surg Date: 2013-11-19 Impact factor: 4.330