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  • Title: Combined intercostal and diaphragm pacing to provide artificial ventilation in patients with tetraplegia.
    Author: DiMarco AF, Takaoka Y, Kowalski KE.
    Journal: Arch Phys Med Rehabil; 2005 Jun; 86(6):1200-7. PubMed ID: 15954060.
    Abstract:
    OBJECTIVE: To evaluate the usefulness of combined intercostal and diaphragm pacing to maintain independence from mechanical ventilation. DESIGN: A prospective trial. SETTING: Clinical research center at a large tertiary hospital. PARTICIPANTS: Four ventilator-dependent subjects with spinal cord injury with only unilateral phrenic nerve function. INTERVENTION: During an initial surgical procedure, a multipolar epidural disk electrode was positioned on the ventral surface of the upper-thoracic spinal cord via a hemilaminectomy to activate the inspiratory intercostal muscles. A phrenic nerve electrode was implanted unilaterally via the thoracic approach. MAIN OUTCOME MEASURES: Inspired volume production and duration that subjects could be comfortably maintained when off mechanical ventilatory support. RESULTS: Initial maximum inspired volumes from combined intercostal and diaphragm stimulation ranged between .23 and .93L and significantly increased over the course of reconditioning period to between 0.55 and 1.31L; subjects could be maintained off mechanical ventilation between 16 and 24 hours a day. CONCLUSIONS: Combined intercostal and unilateral diaphragm pacing may be a useful therapeutic modality capable of maintaining long-term ventilatory support in patients with only unilateral phrenic nerve function.
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