PURPOSE: Background: Diaphragmatic stimulator implant surgery was developed for chronic ventilatory support in 1968. Since then, numerous patients, worldwide, have benefited from its use. In this report, we describe 747 patients, who have received implants over the last 37 years. Rationale: EPR can provide full or partial ventilatory support among patients, who are then able to avoid restrictions- such as airway irritation, decreased venous return and barotrauma, all of which have been associated with invasive and non-invasive positive pressure ventilation. EPR can be used in the community setting, provided appropriate support and follow-up is available.
METHODS: Methods: We reviewed the use of EPR over the past 37 years-using information provided by Avery Biomedical™ (New York, U.S.A.), a leading global equipment provider, which describes the patients’ age, location, diagnosis, date of implantation, type of implant and duration of pacing.
RESULTS: Results: Information was retrieved for 747 patients. The number of implants per year between 1969 and 2006 ranged from 0–52. Subsequent to the initial growth between 1973 and 1987, numbers remained consistent, with a mean per annum frequency of 16.84 ± (SD5.10). Most recipients (71%) received monopolar electrodes with bipolar electrodes being implanted in the remainder. The majority of implants were in the US, with Canada second, followed by Sweden Germany and Italy. There was an early peak in the pediatric population, gradually falling through adolescence and young adulthood but increasing once more in those aged 50–69 years. Most patients treated with EPR (48%) had traumatic quadriplegia, with primary alveolar hypoventilation accounting for 33% and a substantially smaller number of brain stem dysfunction and other miscellaneous conditions.
CONCLUSION: Conclusion: EPR is a viable alternative to conventional ventilation, for carefully selected patients, with spinal cord injury, brain stem dysfunction or central hypoventilation. Regular clinical assessments, effective secretion management and appropriate education enable these complex patients to enjoy increased independence.
CLINICAL IMPLICATIONS: Complex patients with the need for ongoing mechanical ventilation can enjoy improved health related quality of life.
DISCLOSURE: Rachel Heft, No Financial Disclosure Information; No Product/Research Disclosure Information