Phrenic Nerve Pacing

Phrenic Nerve Pacing

Phrenic Nerve Pacing (PNP) or diaphragm pacing, is the rhythmic application of electrical impulses to the diaphragm, resulting in respiration for patients who would otherwise be dependent on a mechanical ventilator.

This concept was originally referred to as electrophrenic respiration, although the Food and Drug Administration identifies the device as a “diaphragmatic/phrenic nerve stimulator”. A phrenic nerve pacemaker is a Class III medical device which requires premarket approval. It should not be confused with an experimental device currently under development (see “diaphragmatic pacemaker”) at Case Western Reserve University.

Indications for Use

According to Medicare, phrenic nerve stimulators are indicated for “selected patients with partial or complete respiratory insufficiency” and “can only be effective if the patient has an intact phrenic nerve and diaphragm.” ("Medicare National Coverage Determinations Manual", Chapter 1, Part 2, Section 160.19) Common patient diagnoses for phrenic nerve pacing include patients with spinal cord injury, central sleep apnea (ie, Ondine's curse), and diaphragm paralysis.

Surgery

The surgery is performed by placing an electrode around the phrenic nerve, either in the neck (ie, cervically), or in the chest (ie, thoracically). This electrode is connected to a radiofrequency receiver which is implanted just under the skin. An external transmitter sends radio signals to the device by an antenna which is worn over the receiver.

For the cervical surgical technique, the phrenic nerve is approached via a small (~5 cm) incision slightly above, and midline to, the clavic. The phrenic nerve is then isolated under the scalenus anticus muscle.

For the thoracic surgical technique, a small (~5 cm) incisions over the 2nd or 3rd intercostal space. The electrodes are placed around the phrenic nerves alongside the pericardium. Use of a thorascope allows for this technique to be performed in a minimally-invasive manner.

Patients are usually hospitalized for 1-3 days post-operatively, although some implantations can be performed on an outpatient basis.

Availability

There are currently two commercially distributed phrenic nerve stimulators made by [http://www.averybiomedical.com Avery Biomedical Devices, Inc.] (USA) and [http://www.atrotech.com Atrotech OY] (Finland). The Avery device (“Mark IV Breathing Pacemaker”) is distributed worldwide. The Atrotech device (“Atrostim Jukka”) is not available in the United States.


Wikimedia Foundation. 2010.

Игры ⚽ Нужен реферат?

Look at other dictionaries:

  • Diaphragm pacing — Contents 1 Introduction 2 Indications for Use 3 Surgery 4 Availability Introduction Diaphragm Pacing, also known as …   Wikipedia

  • Spinal cord injury — Spinal cord injuries Classification and external resources View of the vertebral column and spinal cord ICD 10 G …   Wikipedia

  • Ondine's curse — Classification and external resources ICD 10 G47.3 ICD 9 348.8 …   Wikipedia

  • Diaphragmatic pacemaker — A diaphragmatic pacemaker, in medicine, is a surgically implanted device used to help patients breathe following complications from spinal cord injuries. The device works through pacing of the diaphragm. Mechanism In patients with a diaphragmatic …   Wikipedia

  • electrophrenic — Denoting electrical stimulation of the phrenic nerve usually at its motor point in the neck. SEE ALSO: e. respiration. * * * elec·tro·phren·ic i .lek trə fren ik adj relating to or induced by electrical stimulation of the phrenic nerve… …   Medical dictionary

  • electrophrenic respiration — n artificial respiration by means of an electrophrenic respirator used esp. in poliomyelitis and other conditions in which the nervous control of breathing is impaired * * * (EPR) artificial respiration induced by electric stimulation of the… …   Medical dictionary

  • Pacemaker — A system that sends electrical impulses to the heart in order to set the heart rhythm. The pacemaker can be the normal natural pacemaker of the heart or it can be an electronic device. The natural pacemaker of the heart is the sinus node, one of… …   Medical dictionary

Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”