ABSTRACT
OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Anesthesia/methods , Diaphragm , Electric Stimulation Therapy/methods , Pacemaker, Artificial , Prosthesis Implantation/methods , Respiration, Artificial/methods , Spinal Cord Injuries , Laparoscopy/methods , Perioperative Period , Perioperative Care/methods , Quadriplegia/therapy , Time Factors , Treatment OutcomeABSTRACT
Este estudo é uma revisão atualizada a respeito das duas técnicas de traqueostomia percutânea disponíveis em nosso meio, expondo suas limitações e sua implicação na prática clínica.A técnica mostrou ser uma opção segura, com baixas taxas de morbidade e mortalidade, e aparentemente com menor incidência de complicações tardias quando comparada à técnica convencional cirúrgica, além da possibilidade de ser realizada à beira do leito, sem a necessidade de submeter um paciente de terapia intensiva a um transporte de risco até o centro cirúrgico. Esses fatos tem feito com que a traqueostomia percutânea seja um procedimento que vem sendo cada vez mais utilizado. Entretanto ainda há necessidade de mais estudos controlados comparando a traqueostomia convencional com a percutânea para definir qual dos métodos é mais benéfico para os pacientes.
This study is an updated review about the two percutaneous tracheostomy techniques available in Brazil, addressing their limitations and clinical implications.The method proved to be a safe option, with low rates of morbidity and mortality, and apparently with a lower incidence of late complications comparedto conventional surgical technique, plus the ability to be performed at the bedside, without theneed to transport a critically ill patient to the surgical ward. Consequently. percutaneous tracheostomy is a procedure that has been more widely used. However there is still need formore controlled studies comparing conventional with percutaneous tracheostomy to define which method is most beneficial for patients.