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Point/Counterpoint Editorials |

Point: Should Phrenic Nerve Stimulation Be the Treatment of Choice for Spinal Cord Injury? YesPhrenic Nerve Stimulation? Yes

Lisa F. Wolfe, MD, FCCP
Author and Funding Information

From the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine.

Correspondence to: Lisa F. Wolfe, MD, FCCP, Northwestern University, 675 N St Claire St, Ste 18-250, Chicago, IL 60611; e-mail: lwolfe@northwestern.edu


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: ResMed in the area of complex apnea supported research, Hill-Rom and Philips Respironics for consulting in the area of airway clearance.

The data in this article were presented in a pro-vs-con debate at CHEST 2011; October 22-26, 2011; Honolulu, HI.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(5):1201-1203. doi:10.1378/chest.13-0217
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Every year, roughly 400 Americans experience a spinal cord injury (SCI) that requires long-term invasive mechanical ventilation. Their cost of care is ≥ $100,000 (US) per year, and their life expectancy is 50% less than their counterparts who do not require invasive mechanical ventilation.1

Beginning in 1966, SCI has been treated with electrical stimulation of the phrenic nerves. An updated version of this original device is commonly used in the United States today (Avery Biomedical Devices, Inc). The device uses a cuff electrode placed on the phrenic nerves bilaterally through an open cervical dissection or video-assisted thoracoscopic surgery. These electrodes are attached to a radiofrequency receiver placed under the skin on the upper part of the chest (Fig 1). The stimulation signal is provided by an external transmitter, which relays the signal through an antenna.2 An alternative strategy developed in 2004 uses an electrode deployed intramuscularly to the phrenic nerve with a needle-based system and a laparoscopic approach to the inferior aspect of the diaphragm (Synapse Biomedical Inc).3 These devices require a training period to facilitate improved diaphragmatic strength. The time required to establish an effective, paced ventilation is variable, and patients may continue to show improvement over ≥5 months.4

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