Video-assisted thoracoscopic implantation of a diaphragmatic pacemaker in a child with tetraplegia: indications, technique, and results

J Bras Pneumol, 2014 · DOI: 10.1590/S1806-37132015000100011 · Published: January 1, 2014

Simple Explanation

This article discusses using a 'diaphragmatic pacemaker' to help a child with tetraplegia (paralysis of all four limbs) breathe without a mechanical ventilator. The device sends electrical signals to the phrenic nerve, causing the diaphragm to contract and facilitate breathing. The study highlights the social benefits of using a diaphragmatic pacemaker. It allows patients to reintegrate into society and participate in activities they couldn't while dependent on mechanical ventilation. The paper details the surgical technique used to implant the pacemaker. Specifically, it describes a minimally invasive approach using video-assisted thoracoscopic surgery, which reduces recovery time.

Study Duration

Not specified

Participants

One 5-year-old male child

Evidence Level

Case Report

Key Findings

1
Diaphragmatic pacing can successfully replace mechanical ventilation in children with tetraplegia due to cervical spinal cord injury.
2
Video-assisted thoracoscopic surgery is a feasible and safe method for diaphragmatic pacemaker implantation in pediatric patients, leading to reduced morbidity and accelerated recovery.
3
Diaphragmatic pacing improves the patient's quality of life by enabling social reintegration and resumption of normal activities.

Research Summary

The article reports the case of a 5-year-old child with tetraplegia who received a diaphragmatic pacemaker (DP) via video-assisted thoracoscopic surgery after a cervical spine fracture. The objective was to demonstrate the benefits of this treatment option, focusing on social reintegration and the technical ease of the implantation. The surgical procedure involved implanting electrodes around the phrenic nerve to stimulate diaphragm contraction. The patient was closely monitored during the transition from mechanical ventilation to DP, with the family receiving training to manage the device. The outcome was positive, with the patient able to return to school and participate in social activities. More than a year post-procedure, the child could remain off mechanical ventilation for extended periods, indicating a significant improvement in respiratory function and quality of life.

Practical Implications

Improved Quality of Life

Diaphragmatic pacing allows patients with tetraplegia to regain independence from mechanical ventilation, improving their quality of life and enabling social reintegration.

Minimally Invasive Surgical Approach

Video-assisted thoracoscopic surgery offers a less invasive method for diaphragmatic pacemaker implantation, reducing morbidity and accelerating postoperative recovery.

Expanded Treatment Options

Diaphragmatic pacing provides a valuable alternative for patients with respiratory failure due to spinal cord injuries, congenital conditions, or potentially amyotrophic lateral sclerosis.

Study Limitations

1
This is a case report, which limits the generalizability of the findings.
2
The study focuses on a single patient, and further research is needed to confirm the benefits of diaphragmatic pacing in a larger population.
3
Long-term outcomes and potential complications of diaphragmatic pacing require further investigation.

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