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patient successfully implanted went to a long-term acute care hospital and subsequently had life-prolonging measures withdrawn.)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 A Challenging European Research Project to Develop New Tiny Microscopes
28.03.2017 | Technische Universität Braunschweig

nachricht 3-D visualization of the pancreas -- new tool in diabetes research
15.03.2017 | Umea University

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

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

Im Focus: A Challenging European Research Project to Develop New Tiny Microscopes

The Institute of Semiconductor Technology and the Institute of Physical and Theoretical Chemistry, both members of the Laboratory for Emerging Nanometrology (LENA), at Technische Universität Braunschweig are partners in a new European research project entitled ChipScope, which aims to develop a completely new and extremely small optical microscope capable of observing the interior of living cells in real time. A consortium of 7 partners from 5 countries will tackle this issue with very ambitious objectives during a four-year research program.

To demonstrate the usefulness of this new scientific tool, at the end of the project the developed chip-sized microscope will be used to observe in real-time...

Im Focus: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

Transport of molecular motors into cilia

28.03.2017 | Life Sciences

A novel hybrid UAV that may change the way people operate drones

28.03.2017 | Information Technology

NASA spacecraft investigate clues in radiation belts

28.03.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>