Surgery for Breathing

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We are happy to provide information on the phenic nerve pacemaker and other surgical procedures to treat breathing disorders.

Breathing Pacemakers for Quadriplegics

The phrenic nerves are the pathways between the brain and the diaphragms which originate at C3 through C5. Injuries at or above C3 interrupt these pathways and render the patient dependent on ventilatory assistance. Immediately following injury, this assistance is provided by a mechanical ventilator. After the patient is stable, and cannot be weaned from mechanical ventilation, a breathing pacemaker can be considered.

A breathing pacemaker is a surgically implanted phrenic nerve stimulator which delivers electrical impulses to the diaphragms and restores breathing function. It is indicated for quadriplegia in ventilator-dependent patients whose diaphragm, lungs, and phrenic nerves have residual function. Preoperative screening is determined by the patient's physicians, but typically includes EMG studies of phrenic nerve conduction, and pulmonary function tests.
A breathing pacemaker consists of surgically implanted receivers and electrodes and an external transmitter with antennas worn directly over the implanted receivers.

The external transmitter and antennas send radiofrequency energy to the implanted receivers just under the skin. The receivers then convert the radio waves into stimulating pulses.

These pulses are then sent down the electrodes to the phrenic nerves, causing the diaphragms to contract. This contraction causes inhalation of air. When the pulses stop, the diaphragms relax and exhalation occurs. Repetition of this series of pulses produces a normal breathing pattern.

A breathing pacemaker can provide ventilatory support for patients with chronic respiratory insufficiency whose diaphragm, lungs, and phrenic nerves have residual function. Typically, these patients have high spinal cord injuries, central sleep apnea or other central neurological disorders, or a paralyzed diaphragm.Advantages of Breathing Pacemakers

Pacing has many advantages over positive pressure ventilation, including:

Breathing pacemakers provide respiratory function superior to mechanical ventilators since the inhaled air is drawn into the lungs by the diaphragm under negative pressure, rather than being forced into the chest under positive pressure.

Pacing patients are at much lower risk of ventilator-associated pneumonia (VAP) due to the reduction in suctioning, elimination of external humidifier and ventilator circuits, and the potential removal of the tracheostomy tube in appropriate patients.

Most patients prefer pacing over mechanical ventilation for a variety of reasons including normal breathing and speech patterns, ease of eating and drinking, and its silent operation.

Breathing pacemakers generally cost less than $1,000 per year in disposable supplies (antennas, batteries, etc.) to operate, which is substantially less than the rental fees and disposable supplies associated with a mechanical ventilator. On average, a breathing pacemaker will pay for itself in 3-4 years, and save at least $20,000 per year thereafter.



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