0
Abstract: Poster Presentations |

IMPROVEMENT OF RESPIRATORY MUSCLE DETERIORATION USING THE DIAPHRAGM PACING STIMULATION (DPS) SYSTEM IN PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS (ALS) FREE TO VIEW

Raymond Onders, MD*; Robert Schilz, DO, PhD; Bashar Katirji, MD; MaryJo Elmo, APN; Subhalakashmi Sivashankaran, MD; Anthony Ignagni, MSc
Author and Funding Information

Case Medical Center, Cleveland, OH


Chest


Chest. 2007;132(4_MeetingAbstracts):575. doi:10.1378/chest.132.4_MeetingAbstracts.575
Text Size: A A A
Published online

Abstract

PURPOSE: Respiratory insufficiency is the major cause of mortality in patients with ALS. Ventilators, although life-saving, are inconvenient and associated with significant risks and alternate therapies to prevent or manage respiratory muscle decline in ALS is needed. The motor point diaphragm pacing stimulation (DPS) system has become a standardized minimally invasive laparoscopic technique that can provide ventilation in spinal cord injured patients. We postulate that therapeutic DPS will delay respiratory failure in ALS patient.

METHODS: As part of an FDA trial, patients underwent outpatient laparoscopic diaphragm motor point mapping with electrode implantations. Stimulus/output characteristics of each electrode were determined and diaphragm conditioning initiated. ALS patients conditioned their diaphragms with 5 daily stimulation sessions of 30 minutes each . Each patient had three extensive lead-in assessments that were continued post implantation of the DPS system.

RESULTS: Sixteen patients have been safely implanted with no adverse events. Feeding tubes were safely simultaneously placed in 7 patients. In all patients, more fluoroscopically observed diaphragm excursion occured with diaphragm stimulation than under maximal voluntary effort. DPS significantly increases muscle thickness when assessed with ultrasound (p-value 0.02). After conditioning the diaphragm with the DPS, preliminary results show an average rate of decline in FVC of 1.3% per month from the pre-implantation decline of 3.1% a month, which extrapolates to an additional 15 months of ventilator free survival. Additional findings include: DPS can convert fast twitch glycolytic (IIb) to functional slow twitch oxidative muscle (I) fibers; DPS improves posterior lobe lung ventilation; DPS increases lung compliance leading to decreased work of breathing; and patients have started utilizing DPS to improve nighttime ventilation.

CONCLUSION: The DPS system can be safely implanted and utilized in ALS patients, with a documented decrease in the decline of respiratory failure leading to increased survival. A multi-center pivotal trial is now enrolling patients and collecting data.

CLINICAL IMPLICATIONS: The ability to specifically target and improve diaphragm function with the DPS system will increase therapeutic options in these patients.

DISCLOSURE: Raymond Onders, No Product/Research Disclosure Information; Shareholder Myself, my university and my hospital have intellectual property rights and founded a company that manufactures some technology used in this study

Wednesday, October 24, 2007

12:30 PM - 2:00 PM


Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543