Choosing of a diaphragmatic pacer

[kikosaez]

Hi,
My wife has been connected to mechanic ventilation for 8 months and she has now the possibility of be eligible for a diaphragmatic pacer. We live in Spain and we have the possibility of choosing about the phrenic nerve stimulator or the newer one developed by Dr. Onders. Could somebody tell me which should we choose and why?
Thank you

[Scaper1]

Hi Kiko. Which European models do you have to decide between? I have the Atrostim system, but only because that was the best choice 20 years ago. If I was making the decision today it would be the Onders model as the surgery is much less invasive.

[kikosaez]

I don't know which is the model of the phrenic nerve stimulator. I will try to find out. Howver, besides the surgery (which is important, of course), is any other difference in probability of success (probability of getting rid of the mechanic ventilation) and functionality between both options?

[Scaper1]

Has your wife been through the testing? I really can't speak to the current probability of success, but I think they're both quite high.

[Wise Young]

I don't know which is the model of the phrenic nerve stimulator. I will try to find out. Howver, besides the surgery (which is important, of course), is any other difference in probability of success (probability of getting rid of the mechanic ventilation) and functionality between both options?

Kikosaez,

The first decision is whether or not to do a phrenic nerve or diaphragm stimulation. The former is less invasive and consist of putting the stimulating electrodes around the phrenic nerve in the neck. That latter involves placing the stimulating electrodes into the diaphragm. I know many people who have received phrenic nerve or diaphragm stimulators as long as 20 years ago and the stimulators are working well. In recent years, some spinal cord injury centers are placing diaphragm stimulators early after spinal cord injury, within weeks, to prevent diaphragm atrophy.

Dr. Raymond Onders developed a non-invasive way of placing the electrodes into the diaphragm without having to open up the abdomen. Please note that while this device has been approved and the implantaton is less invasive, I am not sure that it is more reliable than the traditional method of open surgery and placement of the electrodes on the diaphragm. While Christopher Reeve was the third person to get a diaphragm stimulator from Dr. Onders, Christopher had not gotten off the respirator while on that stimulator. Christopher also had a fever of unknown origin after he received that stimulator and the cause of the fever is unknown. Onder developed a method to introduce a probe laparascopically (through a tube inserted in the belly) to stimulate and map the diaphragm before placing the electrodes. http://www.ncbi.nlm.nih.gov/pubmed/15467667

Diaphragm pacing has been used for over 40 years and some centers are introducing the stimulators early in people on respirators (within weeks) instead of waiting months, as in the case of your wife. As you know, respirators cause atrophy of the diaphragm. The longer that one waits, the more likely that the electrodes may not work at the beginning and a longer process of weaning from the respirator will be needed. In recent years, better diaphragm electrodes have been developed, as well as more reliable stimulators. I think that you should rely on the recommendation of your surgeon. The pacer itself is not as important as the method that is used to place the electrodes.

Wise.

[BillMiller823]

Kikosaez,

Dr. Young's advice is always good and as objective as can be, and I don't wish to contradict it. However, when I sought an alternative to my ventilator, I did choose the Diaphragm Pacing System (DPS) developed by Dr. Onders.

I believe it is the best overall method available, unfortunately, we discovered that I actually have zero innervation of my diaphragm, and even when my surgeon was inside me and attempted to stimulate my diaphragm with the DPS, it was unsuccessful. But another member here, Trainman, had successful DPS surgery back in November of last year and he recently had his ventilator removed from his wheelchair because he's so comfortable with the DPS.

Trainman, myself, and additional members discuss the DPS and more here:

https://www.carecure.net/forum/showthread.php?t=134394

Whatever you decide... I hope it works -- God bless!

Bill Miller

[ChuckFoss]

Just to throw in my 2 cents worth....I had the phrenic nerve stimulator implanted in 1981 at Yale-New Haven hospital in Connecticut and have been loving it since day one. More info on the phrenic nerve type can be found at http://www.averybiomedical.com/index.html