DIAPHRAGM PACING FOR RESPIRATORY INSUFFICIENCY

Diaphragm pacing (DP) by electrical stimulation of the phrenic nerve o ffers important advantages to a highly select group of patients with r espiratory paralysis. The patient wears an external radiofrequency (RF ) transmitter over an implanted receiver, and a stimulating current is induced without the need for any transcutaneous wires. We review the conditions and requirements of patients who may benefit most from DP. We outline the preoperative evaluation and procedures for surgical imp lantation. We discuss the risk of diaphragmatic fatigue posed by initi ation of DP and the use of gradual conditioning to limit this problem. Other problems encountered by patients in the course of DP can be min imized by well-instructed home caregivers and by systematic medical fo llow-up. Although a few patients derive considerable benefit from DP, many patients with respiratory paralysis are better treated by less in vasive means such as nasal bilevel positive airway pressure or intermi ttent positive pressure ventilation, which we also review.