This page covers the management of diaphragmatic paralysis presenting as bilateral diaphragmatic dysfunction in patients where phrenic nerve electrical conduction remains intact — a sub-population with a distinct, device-based therapeutic pathway.
Bilateral diaphragmatic dysfunction results in significant impairment of respiratory muscle function. In selected cases, the phrenic nerve pathway retains its electrical conductivity despite loss of effective diaphragmatic activity. Demonstrating that integrity is a prerequisite for the intervention applicable to this scenario.
Primary candidates for this approach are patients in whom respiratory drive is impaired at a central level while the peripheral phrenic nerve remains electrically intact.
When phrenic nerve conduction is confirmed intact, a device-based intervention involving electrical stimulation of the phrenic nerve is a recognised therapeutic option. The stimulation drives diaphragmatic contraction and breath generation. Stimulation can be delivered at different anatomical levels depending on the clinical picture.
In selected cases of patients with bilateral diaphragmatic dysfunction, diaphragm pacing is a therapeutic option that consists of a device that electrically stimulates the phrenic nerve, resulting in diaphragmatic contraction and generation of breath.
The primary candidates for this therapy are patients with high cervical spinal cord injuries (above C3), with damage to the respiratory bulbospinal pathways but integrity of the phrenic nerve roots.
It is necessary to demonstrate the integrity of electrical conduction in the phrenic nerve, and stimulation can be performed at cervical, thoracic or diaphragmatic level (on phrenic nerve insertion in the diaphragm), depending on the site of injury.
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