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THE EFFECTIVENESS OF DIAPHRAGM PACING FOR RESPIRATORY PARALYSIS
Purpose: Diaphragm pacing (DP) is a promising new therapy for respiratory paralysis. The purpose of this review was to determine the effectiveness of DP through a critical appraisal of the literature. Methods: Medline and CINAHL databases were searched for original studies and background reviews from 1985-1999, using the key terms diaphragm, electrical stimulation, pacing, phrenic nerve, and respiration. A secondary search was also conducted. Results: Forty articles were accepted for the review. Data from sufficiently detailed studies (n=17) were combined to quantitatively examine four variables: DP outcomes, complications, current living situation, and vocational status. DP provided complete or significant respiratory support for 78.2% of subjects (n=358). Failure of system components occurred at an average of 1.03 incidences per subject (n=106), but could usually be rectified without severe consequence. 73.3% of subjects (n=86) were able to live at home with family/nursing care, reducing the need for institutionalization. In four studies documenting vocational status, 56% of subjects were employed, attending school, or volunteering. One study (n=22) reported greater cost effectiveness, subjective satisfaction, and less time devoted to ventilatory assistance for DP vs. mechanical ventilation. Conclusion: DP has been shown to provide satisfactory respiratory support for individuals with respiratory paralysis, eliminating or greatly reducing the need for mechanical ventilation, thus allowing for increased mobility and improved functional status. Careful patient selection is essential in achieving success. Further technological developments will likely decrease the incidence of complications and broaden the spectrum of patients who could benefit from this intervention. Clinical Relevance: With increasing survival rates in high spinal cord and brainstem injuries, clinicians will be called upon to provide comprehensive functional rehabilitation. Familiarity with assistive equipment such as the diaphragm pacer is essential in the rehabilitation of these individuals.