TREATMENT OF CHRONIC VENTILATORY FAILURE USING A DIAPHRAGMATIC PACEMAKER

We present our series of patients with chronic ventilatory failure tre ated with electrophrenic respiration: 13 males and nine females with a mean age of 12+/-11.5 years. The etiology was, 13 tetraplegia, five s equelae of surgical treatment of intracranial lesions, and four centra l alveolar hypoventilation. The mean duration of the conditioning peri od were 3-4 months. Eighteen patients (81.8%) achieved permanent, diap hragmatically-paced breathing with bilateral stimulation and in four ( 18.2%) patients, pacing was only during sleep. Five patients died (22. 7%). two during the hospital stay and three at home; two deaths had un known cause and three were due respectively to, lack of at-home care, recurrence of an epidermoid tumor, and sequelae of accidental disconne ction of the mechanical ventilation before beginning the conditioning period. Two cases were considered failures: One patient had transitory neurapraxia lasting 80 days, and the other had an ischemic spinal cor d syndrome with progressive deterioration of the left-side response to stimulation. One patient had right phrenic nerve entrapment by scar t issue and four suffered infections. The follow-up periods since pacema ker implantation are currently: 1, 11 years; 4, 10 years, and 17, less than 5 years. The results of our experience demonstrate that complete stable ventilation can be achieved using diaphragmatic pacing and tha t it improves the prognosis and life quality of patients with severe c hronic respiratory failure.