[Diaphragmatic pacemaker dysfunction and utility of diaphragmatic ultrasonography]. / Disfunción de marcapasos diafragmático y utilidad de la ecografía diafragmática.

Patients with spinal cord injuries above the C5 vertebrae have a high risk of respiratory complications, and complete spinal cord injures can require support with mechanical ventilation. In selected patients, implantation of a diaphragmatic pacemaker offers the possibility of breathing without mechanical support and reduces respiratory complications, increasing the patient's independence. Ultrasonography is a simple and non-invasive technique that may be useful in the differential diagnosis of thoracic diseases. We present the case of a patient with a traumatic cervical spinal cord injury, who underwent diaphragmatic pacemaker implantation. The use of ultrasound allowed rapid and reliable diagnosis of device malfunction. M-mode diaphragmatic ultrasonography is a simple and non-invasive technique that can be incorporated into routine clinical practice to diagnose diaphragm movement disorders.

Disfunción de marcapasos diafragmático y utilidad de la ecografía diafragmática / Diaphragmatic pacemaker dysfunction and utility of diaphragmatic ultrasonography

Los pacientes con lesiones medulares por encima de C5 presentan un alto riesgo de complicaciones respiratorias y en el caso de las lesiones medulares completas la mayoría requerirán soporte con ventilación mecánica de forma permanente. En pacientes seleccionados el implante de un marcapasos diafragmático ofrece la posibilidad de respirar sin soporte mecánico y representa una reducción de complicaciones respiratorias proporcionando al paciente mayor independencia. La ecografía supone una técnica sencilla y no invasiva que puede ser útil para el diagnóstico diferencial de patología torácica. Presentamos el caso de un paciente con lesión medular cervical traumática, al que le fue implantado un marcapasos diafragmático y en el que el uso de la ecografía permitió un diagnóstico rápido y fiable de una disfunción del dispositivo. La ecografía diafragmática en modo M es una técnica sencilla y no invasiva que se puede incorporar en la práctica clínica habitual para diagnosticar trastornos del movimiento del diafragma

Patients with spinal cord injuries above the C5 vertebrae have a high risk of respiratory complications, and complete spinal cord injures can require support with mechanical ventilation. In selected patients, implantation of a diaphragmatic pacemaker offers the possibility of breathing without mechanical support and reduces respiratory complications, increasing the patient's independence. Ultrasonography is a simple and non-invasive technique that may be useful in the differential diagnosis of thoracic diseases. We present the case of a patient with a traumatic cervical spinal cord injury, who underwent diaphragmatic pacemaker implantation. The use of ultrasound allowed rapid and reliable diagnosis of device malfunction. M-mode diaphragmatic ultrasonography is a simple and non-invasive technique that can be incorporated into routine clinical practice to diagnose diaphragm movement disorders

Marcapasos diafragmático como alternativa a la ventilación mecánica en el paciente con lesión medular cervical / Diaphragmatic pacemaker as an alternative to mechanical ventilation in patients with cervical spinal injury

Objetivo Comprobar que el marcapasos diafragmático es una forma de soporte respiratorio que puede usarse para facilitar la retirada del respirador volumétrico en pacientes con lesión medular cervical y parálisis diafragmática, mediante su comparación con el respirador volumétrico tradicional. Diseño Análisis retrospectivo de una base de datos prospectiva y de tipo caso-control apareado por edad. Ámbito Unidad de Cuidados Intensivos y Unidad de Cuidados Intermedios Respiratorios del Hospital Nacional de Parapléjicos de Toledo. Pacientes Se han recogido los datos de todos los pacientes dados de alta del hospital con soporte respiratorio permanente mediante respirador volumétrico o marcapasos diafragmático con un periodo de seguimiento de 25 años y se han realizado entrevistas personales para valorar la calidad de vida relacionada con la salud. Para las comparaciones estadísticas se han usado tests de comparaciones y de supervivencia. Intervenciones Cuestionario de calidad de vida. Variables de interés Datos demográficos y clínicos, estancia hospitalaria, mortalidad, readaptación familiar y calidad de vida relacionada con la salud. Resultados Hemos examinado las historias clínicas de 101 pacientes, 37 con marcapasos y 64 con un respirador volumétrico. Nuestros resultados muestran tanto una duración del ingreso en UCI y de la hospitalización como una reintegración familiar sin diferencias significativas, con tendencia a una mayor supervivencia en los pacientes con marcapasos (18,18 frente a 9,67 años por el método de Kaplan-Meier, p<0,001), aunque esta diferencia deja de ser estadísticamente significativa (p=0,06) tras controlar (..) (AU)

Objective To verify that the diaphragmatic pacemaker is a form of respiratory support that can be used to replace a volumetric respirator in cervical spinal injury patients with cervical spinal lesion and diaphragmatic paralysis by means of its comparison with the traditional volumetric respirator. Design Retrospective study of a prospective database and age-matched case-control study. Setting Intensive Care Unit and Intermediate Care Respiratory Unit, Paraplegics National Hospital, Toledo (Spain).Patients We collected data on all patients discharged from the Hospital with permanent respiratory support by volumetric respirator or diaphragmatic pacemaker during a follow-up period of 25 years. Personal interviews were conducted to evaluate health-related quality of life. Comparison and survival tests were used for statistical comparisons. Interventions Quality of life questionnaire. Main variables The main variables collected were demographic data, hospital stay, mortality, family reintegration and health-related quality of life. Results We evaluated the clinical records of 101 patients, 37 in the pacemaker-group and 64 in the volumetric respirator-group. Our results show that ICU admission duration and hospitalization as well as family reintegration, without significant differences, with a tendency to greater survival in pacemaker patients (18.18 versus 9.67 years by the Kaplan-Meier method, p<0.001). However, this difference becomes non-significant (p=0.06) after adjustment of the groups by age. Furthermore, better quality of life was found in these same patients with pacemakers in terms of security, communication, sociability, comfort and mobility in the patients. Conclusions Diaphragmatic pacemaker ventilation is an effective alternative to mechanical ventilation with similar efficacy that improve quality of life in patients with severe respiratory failure due to cervical spinal cord injury (AU)

[Diaphragmatic pacemaker as an alternative to mechanical ventilation in patients with cervical spinal injury]. / Marcapasos diafragmático como alternativa a la ventilación mecánica en el paciente con lesión medular cervical.

OBJECTIVE: To verify that the diaphragmatic pacemaker is a form of respiratory support that can be used to replace a volumetric respirator in cervical spinal injury patients with cervical spinal lesion and diaphragmatic paralysis by means of its comparison with the traditional volumetric respirator. DESIGN: Retrospective study of a prospective database and age-matched case-control study. SETTING: Intensive Care Unit and Intermediate Care Respiratory Unit, Paraplegics National Hospital, Toledo (Spain). PATIENTS: We collected data on all patients discharged from the Hospital with permanent respiratory support by volumetric respirator or diaphragmatic pacemaker during a follow-up period of 25 years. Personal interviews were conducted to evaluate health-related quality of life. Comparison and survival tests were used for statistical comparisons. INTERVENTIONS: Quality of life questionnaire. MAIN VARIABLES: The main variables collected were demographic data, hospital stay, mortality, family reintegration and health-related quality of life. RESULTS: We evaluated the clinical records of 101 patients, 37 in the pacemaker-group and 64 in the volumetric respirator-group. Our results show that ICU admission duration and hospitalization as well as family reintegration, without significant differences, with a tendency to greater survival in pacemaker patients (18.18 versus 9.67 years by the Kaplan-Meier method, p<0.001). However, this difference becomes non-significant (p=0.06) after adjustment of the groups by age. Furthermore, better quality of life was found in these same patients with pacemakers in terms of security, communication, sociability, comfort and mobility in the patients. CONCLUSIONS: Diaphragmatic pacemaker ventilation is an effective alternative to mechanical ventilation with similar efficacy that improve quality of life in patients with severe respiratory failure due to cervical spinal cord injury.