Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Diaphragm pacing in spinal cord injury successful in weaning patients from ventilators

10.02.2014
System gained nationwide attention when University Hospitals Case Medical Center's Dr. Onders implanted stimulator in actor Christopher Reeve

A new study published in the Journal of Trauma and Acute Care Surgery finds that diaphragm pacing (DP) stimulation in spinal cord-injured patients is successful not only in weaning patients from mechanical ventilators but also in bridging patients to independent respiration, where they could breathe on their own without the aid of a ventilator or stimulation.

The stimulation is provided by the Diaphragm Pacing System (DPS), a technology providing electrical stimulation to nerves running through the diaphragm, the major muscle involved in breathing. When stimulated, the diaphragm contracts, allowing patients to breathe more naturally than having air forced into their lungs as a mechanical ventilator would do. The system is implanted through minimally invasive laparoscopic surgery.

One of the inventors of DPS and an author of the new study is Raymond Onders, MD, of University Hospitals (UH) Case Medical Center. DPS gained national attention in 2003 when Dr. Onders, Director of Minimally Invasive Surgery at UH, implanted the system in the late actor Christopher Reeve, who had a traumatic spinal cord injury (SCI) from a horse-riding accident.

The new study examined the records of 29 patients, average age 31, at 16 hospitals in the United States where DP implantation is approved. SCIs were caused by a variety of accidents, including car accidents, diving, gunshot wounds, falls, and athletic injuries. Elapsed time from injury to surgery was 40 days, which was considerably shorter than an initial FDA trial in which patients did not have DP testing and surgery for more than a year after injury. All but two patients were men. A goal of this study was to determine if earlier testing and DP implants provided benefit.

Of the patients whose diaphragm muscles responded to stimulation, 16 of 22 patients (72 percent) were completely free of ventilator support in an average of 10 days. Of the remaining six patients, two had a delayed weaning of six months, three had partial weans using DP at times during the day (One patient successfully implanted went to a long-term acute care hospital and subsequently had life-prolonging measures withdrawn.) Seven of the 29 patients were found to have non-stimulatable diaphragms from nerve damage.

Eight patients (36 percent) had complete recovery of respiration, and DP wires were removed.

"This study provides several important observations," said Dr. Onders, who is also Professor of Surgery at Case Western Reserve University School of Medicine. "Most notably, laparoscopic diaphragm mapping – an electronic reading of the diaphragm nerves – is safe and can be performed in multiple centers with success. In addition, early diaphragm mapping can quickly determine if a phrenic nerve injury is complete, allowing for early ventilator planning and prevention of weaning trials if we find the patient will not be able to be weaned from the ventilator. Finally, DP can successfully wean traumatic cervical SCI patients as evidenced by 72 percent of the implanted patients being completely weaned from ventilators and 36 percent with complete recovery and DP removal.

"DP is a major step in improving the quality of life for patients who have spinal cord injuries and cannot breathe without the help of a ventilator," said Dr. Onders. "Based on testimonials that I've received from patients who have been in the clinical trials, DP provides patients with a freedom of mobility that they never imagined. They've sent photographs or videos themselves parachuting from planes, sailing solo, or enjoying rides at amusement parks with their families; activities impossible to do with a ventilator."

Traumatic spinal cord injuries (SCIs) that require chronic ventilator dependence are relatively rare: Less than four percent or 480 cases out of the estimated 12,000 traumatic SCIs occurring annually in the United States.

DPS has also been approved for patients with amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease) and is being used in patients with other conditions as well.

DPS is made by Synapse Biomedical, Inc., a company co-founded by Dr. Onders and located in Oberlin, Ohio. Dr. Onders, UH Case Medical Center, and Case Western Reserve University have intellectual property rights in Synapse.

About University Hospitals

University Hospitals, the second largest employer in Northeast Ohio, serves the needs of patients through an integrated network of hospitals, outpatient centers and primary care physicians in 16 counties. At the core of our health system is University Hospitals Case Medical Center, one of only 18 hospitals in the country to have been named to U.S. News & World Report's most exclusive rankings list: the Best Hospitals 2013-14 Honor Roll. The primary affiliate of Case Western Reserve University School of Medicine, UH Case Medical Center is home to some of the most prestigious clinical and research centers of excellence in the nation and the world, including cancer, pediatrics, women's health, orthopaedics and spine, radiology and radiation oncology, neurosurgery and neuroscience, cardiology and cardiovascular surgery, organ transplantation and human genetics. Its main campus includes the internationally celebrated UH Rainbow Babies & Children's Hospital, ranked among the top children's hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center at Case Western Reserve University. UH Case Medical Center is the 2012 recipient of the American Hospital Association – McKesson Quest for Quality Prize for its leadership and innovation in quality improvement and safety.

George Stamatis | EurekAlert!
Further information:
http://www.uhhospitals.org

More articles from Medical Engineering:

nachricht Skin patch dissolves 'love handles' in mice
18.09.2017 | Columbia University Medical Center

nachricht Medicine of the future: New microchip technology could be used to track 'smart pills'
13.09.2017 | California Institute of Technology

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

Im Focus: Fast, convenient & standardized: New lab innovation for automated tissue engineering & drug

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems Holding GmbH about commercial use of a multi-well tissue plate for automated and reliable tissue engineering & drug testing.

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems...

Im Focus: Silencing bacteria

HZI researchers pave the way for new agents that render hospital pathogens mute

Pathogenic bacteria are becoming resistant to common antibiotics to an ever increasing degree. One of the most difficult germs is Pseudomonas aeruginosa, a...

Im Focus: Artificial Enzymes for Hydrogen Conversion

Scientists from the MPI for Chemical Energy Conversion report in the first issue of the new journal JOULE.

Cell Press has just released the first issue of Joule, a new journal dedicated to sustainable energy research. In this issue James Birrell, Olaf Rüdiger,...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

IVAM’s LaserForum visits the Swiss canton of St. Gallen with the topic ultrashort pulse lasers

06.09.2017 | Event News

 
Latest News

Robust and functional – surface finishing by suspension spraying

19.09.2017 | Materials Sciences

The Wadden Sea and the Elbe Studied with Zeppelin, Drones and Research Ships

19.09.2017 | Earth Sciences

Digging sensors out of an efficiency hole

19.09.2017 | Materials Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>