Diaphragm pacing, a form of artificial ventilation, relies on implanted phrenic nerve electrodes and receivers to help patients breathe. An external transmitter sends a train of impulses to the implanted receivers, which in turn send a signal to the electrodes on the phrenic nerves. The intact phrenic nerve-diaphragm axis transmits the phrenic nerve stimulation signal to result in a diaphragm contraction and the patient’s paced breath.
Lurie Children’s is one of only two institutions in the country using the advanced, minimally invasive technique for thoracoscopic diaphragm pacer implantation. The Lurie Children’s Center for Autonomic Medicine in Pediatrics (CAMP) program is the largest diaphragm pacing center in the world. The surgical placement of the pacers, the electrophysiological setting of the pacers and the ongoing patient care have given CAMP and Lurie Children’s extensive experience and expertise in diaphragm pacing.
The diaphragm pacing team (CAMP and the Division of Pediatric Surgery) continues to develop innovative ways of using this technology to improve the quality of life for ventilator-dependent children and young adults. Our long-term goal is to develop totally implantable biofeedback diaphragm pacers.
Though children still require a tracheostomy when they have diaphragm pacing (at least initially), the use of diaphragm pacers offers an alternative to traditional mechanical ventilation in children whose breathing requires continuous mechanical ventilation. Diaphragm pacing has a potential role for young adults who depend on ventilators during sleep only, though there is no guarantee that the tracheostomy tube can be removed in all cases.
Patients who need the pacing — such as children with congenital central hypoventilation syndrome (CCHS) and occasionally those with rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD) or Chiari-II malformation — are admitted to the hospital, where the procedure is performed by a special team of pediatric surgeons with expertise in the thoracoscopic technique. Follow-up care is through CAMP.