Diaphragmatic pacemaker as an alternative to mechanical ventilation in patients with cervical spinal injury

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. (C) 2009 Elsevier Espana, S.L. and SEMICYUC. All rights reserved.