Inpatient diaphragm pacer admissions
Diaphragm pacing, an alternative form of artificial ventilation, relies on thoracoscopically implanted phrenic nerve electrodes and receivers. An external transmitter communicates a battery-generated train of impulses to antennae that lie over the subcutaneously implanted receivers. The antennae convert the electrical impulse into a radiofrequency signal, and that signal is detected by the implanted receivers. The receivers, connected to the phrenic nerve electrodes, generate a signal that will be detected by the phrenic nerve, and the intact phrenic nerve-diaphragm results in the patient generating a breath.
Though children still require a tracheostomy when they have diaphragm pacing, the pacing procedure offers an alternative to traditional mechanical ventilation in children whose breathing depends 24 hours per day on a ventilator. Diaphragm pacing might also be needed in young adults who depend on ventilators only during sleep, though there is no guarantee that the tracheostomy tube can be removed in all cases.
Patients who need the pacing — such as children with CCHS and occasionally those with Chiari-II malformation — are admitted to the hospital, where the procedure is performed via thoracoscopic implantation by a pediatric thoracic surgeon. This hospital is one of only two institutions in the country using this advanced, minimally invasive technique. The placement of the pacers, the electrophysiologically setting of the pacers, and the ongoing management of these patients requires the expertise of the largest program in the world for diaphragm pacing in children.
Furthermore, the team continues to develop innovative ways of using this technology to improve the quality of life for ventilator-dependent children. The long-term aim is development of totally implantable biofeedback diaphragm pacers.