Phrenic Nerve Pacing

Jump to navigation Jump to search

WikiDoc Resources for Phrenic Nerve Pacing

Articles

Most recent articles on Phrenic Nerve Pacing

Most cited articles on Phrenic Nerve Pacing

Review articles on Phrenic Nerve Pacing

Articles on Phrenic Nerve Pacing in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Phrenic Nerve Pacing

Images of Phrenic Nerve Pacing

Photos of Phrenic Nerve Pacing

Podcasts & MP3s on Phrenic Nerve Pacing

Videos on Phrenic Nerve Pacing

Evidence Based Medicine

Cochrane Collaboration on Phrenic Nerve Pacing

Bandolier on Phrenic Nerve Pacing

TRIP on Phrenic Nerve Pacing

Clinical Trials

Ongoing Trials on Phrenic Nerve Pacing at Clinical Trials.gov

Trial results on Phrenic Nerve Pacing

Clinical Trials on Phrenic Nerve Pacing at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Phrenic Nerve Pacing

NICE Guidance on Phrenic Nerve Pacing

NHS PRODIGY Guidance

FDA on Phrenic Nerve Pacing

CDC on Phrenic Nerve Pacing

Books

Books on Phrenic Nerve Pacing

News

Phrenic Nerve Pacing in the news

Be alerted to news on Phrenic Nerve Pacing

News trends on Phrenic Nerve Pacing

Commentary

Blogs on Phrenic Nerve Pacing

Definitions

Definitions of Phrenic Nerve Pacing

Patient Resources / Community

Patient resources on Phrenic Nerve Pacing

Discussion groups on Phrenic Nerve Pacing

Patient Handouts on Phrenic Nerve Pacing

Directions to Hospitals Treating Phrenic Nerve Pacing

Risk calculators and risk factors for Phrenic Nerve Pacing

Healthcare Provider Resources

Symptoms of Phrenic Nerve Pacing

Causes & Risk Factors for Phrenic Nerve Pacing

Diagnostic studies for Phrenic Nerve Pacing

Treatment of Phrenic Nerve Pacing

Continuing Medical Education (CME)

CME Programs on Phrenic Nerve Pacing

International

Phrenic Nerve Pacing en Espanol

Phrenic Nerve Pacing en Francais

Business

Phrenic Nerve Pacing in the Marketplace

Patents on Phrenic Nerve Pacing

Experimental / Informatics

List of terms related to Phrenic Nerve Pacing

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Overview

Phrenic Nerve Pacing (PNP) or diaphragm pacing, is the rhythmic application of electrical impulses to the diaphragm, resulting in respiration for patients who would otherwise be dependent on a mechanical ventilator.

This concept was originally referred to as electrophrenic respiration, although the Food and Drug Administration identifies the device as a “diaphragmatic/phrenic nerve stimulator”. A phrenic nerve pacemaker is a Class III medical device which requires premarket approval. It should not be confused with an experimental device currently under development (see “diaphragmatic pacemaker”) at Case Western Reserve University.

Indications for Use

According to Medicare, phrenic nerve stimulators are indicated for “selected patients with partial or complete respiratory insufficiency” and “can only be effective if the patient has an intact phrenic nerve and diaphragm.” (Medicare National Coverage Determinations Manual, Chapter 1, Part 2, Section 160.19) Common patient diagnoses for phrenic nerve pacing include patients with spinal cord injury, central sleep apnea (ie, Ondine's curse), and diaphragm paralysis.

Surgery

The surgery is performed by placing an electrode around the phrenic nerve, either in the neck (ie, cervically), or in the chest (ie, thoracically). This electrode is connected to a radiofrequency receiver which is implanted just under the skin. An external transmitter sends radio signals to the device by an antenna which is worn over the receiver.

For the cervical surgical technique, the phrenic nerve is approached via a small (~5 cm) incision slightly above, and midline to, the clavic. The phrenic nerve is then isolated under the scalenus anticus muscle.

For the thoracic surgical technique, a small (~5 cm) incisions over the 2nd or 3rd intercostal space. The electrodes are placed around the phrenic nerves alongside the pericardium. Use of a thorascope allows for this technique to be performed in a minimally-invasive manner.

Patients are usually hospitalized for 1-3 days post-operatively, although some implantations can be performed on an outpatient basis.

Availability

There are currently two commercially distributed phrenic nerve stimulators made by Avery Biomedical Devices, Inc. (USA) and Atrotech OY (Finland). The Avery device (“Mark IV Breathing Pacemaker”) is distributed worldwide. The Atrotech device (“Atrostim Jukka”) is not available in the United States.

Template:SIB

de:Elektrolunge