Patients with chronic apnea, either due to cervical spine trauma or diseases, such as ALS, may benefit from Diaphragmatic Pacing.

Improvement in the quality of life has been demonstrated in these patients by delaying the need for mechanical ventilation and decreasing the incidence of pulmonary infections.

Phrenic nerve stimulation or direct diaphragmatic stimulation are preformed via implanted electrodes connected to a radiofrequency receiver which receives radio signals from an external transmitter.

Candidates for phrenic nerve stimulation must have intact phrenic nerve cell bodies, therefore patients with lower motor neuron diseases, such as ALS or damage to the cervical spine bellow C2, may be treated with direct diaphragmatic pacing only.

The electrodes are placed using minimally invasive surgical techniques. Phrenic nerve pacers are placed using cervical or thoracic approaches. Diaphragmatic pacers are placed laparascopically at diaphragmatic motor points, attachment points of the phrenic nerve on the diaphragm. These points are mapped using specialized computer software.

This procedure was developed at University Hospitals Case Western Medical Center. Patients include Christopher Reeves, who suffered a cervical spine injury following a riding accident leaving him quadriplegic and respirator dependent.

Reeves: "“The constant and high cost of care for ventilator-dependent patients not only exhausts most insurance policies but contributes to strain on families and caregivers. Once this procedure receives FDA approval, these patients and their caregivers should be able to achieve significant improvements in their quality of life.”

This procedure has been FDA approved since 2008 and is now gaining worldwide accreditation for its role in ICU patient rehabilitation.