Diaphragmatic pacemaker as an alternative to mechanical ventilation in patients with cervical spinal injury
Marcapasos diafragmático como alternativa a la ventilación mecánica en el paciente con lesión medular cervical
F.J. Romero-Ganuza
, C. Gambarrutta-Malfatti, E. Diez de la Lastra-Buigues, M.Á. Marín-Ruiz, V.E. Merlo-González, A.M. Sánchez-Aranzueque Pantoja, F.J. García-Moreno, J. Mazaira-Álvarez
Corresponding author
UCI y Unidad de Cuidados Intermedios Respiratorios, Hospital Nacional de Parapléjicos de Toledo, Toledo, Spain
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"apellidos" => "Romero-Ganuza" "email" => array:1 [ 0 => "fjromero@sescam.jccm.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Gambarrutta-Malfatti" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Diez de la Lastra-Buigues" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Marín-Ruiz" ] 4 => array:2 [ "nombre" => "V.E." "apellidos" => "Merlo-González" ] 5 => array:2 [ "nombre" => "A.M." "apellidos" => "Sánchez-Aranzueque Pantoja" ] 6 => array:2 [ "nombre" => "F.J." "apellidos" => "García-Moreno" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Mazaira-Álvarez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "UCI y Unidad de Cuidados Intermedios Respiratorios, Hospital Nacional de Parapléjicos de Toledo, Toledo, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Marcapasos diafragmático como alternativa a la ventilación mecánica en el paciente con lesión medular cervical" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-09-08" "fechaAceptado" => "2010-10-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec10668" "palabras" => array:5 [ 0 => "Spinal cord injuries" 1 => "Artificial respiration" 2 => "Diaphragmatic pacemaker" 3 => "Survival analysis" 4 => "Quality of life" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec10669" "palabras" => array:5 [ 0 => "Lesión medular cervical" 1 => "Ventilación mecánica" 2 => "Marcapasos diafragmático" 3 => "Supervivencia" 4 => "Calidad de vida" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of a prospective database and age-matched case control study.</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Intensive Care Unit and Intermediate Care Respiratory Unit, Paraplegics National Hospital, Toledo (Spain).</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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 qualify of life. Comparison and survival tests were used for statistical comparisons.</p> <span class="elsevierStyleSectionTitle">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Quality of life questionnaire.</p> <span class="elsevierStyleSectionTitle">Main variables</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The main variables collected were demographic data, hospital stay, mortality, family reintegration and health-related quality of life.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). However, this difference becomes non-significant (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.06) after adjustment of the groups by age. Furthermore, better quality of life was found in the same patients with pacemakers in terms of security, communication, sociability, comfort and mobility in the patients.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comprobar que el marcapasos diafragmático es una forma de soporte respiratorio que puede usarse para facilitar la retirada del respirador volumétrico en pacientes con lesión medular cervical y parálisis diafragmática, mediante su comparación con el respirador volumétrico tradicional.</p> <span class="elsevierStyleSectionTitle">Diseño</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Análisis retrospectivo de una base de datos prospectiva y de tipo caso-control apareado por edad.</p> <span class="elsevierStyleSectionTitle">Ámbito</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Unidad de Cuidados Intensivos y Unidad de Cuidados Intermedios Respiratorios del Hospital Nacional de Parapléjicos de Toledo.</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se han recogido los datos de todos los pacientes dados de alta del hospital con soporte respiratorio permanente mediante respirador volumétrico o marcapasos diafragmático con un periodo de seguimiento de 25 años y se han realizado entrevistas personales para valorar la calidad de vida relacionada con la salud. Para las comparaciones estadísticas se han usado tests de comparaciones y de supervivencia.</p> <span class="elsevierStyleSectionTitle">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Cuestionario de calidad de vida.</p> <span class="elsevierStyleSectionTitle">Variables de interés</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Datos demográficos y clínicos, estancia hospitalaria, mortalidad, readaptación familiar y calidad de vida relacionada con la salud.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Hemos examinado las historias clínicas de 101 pacientes, 37 con marcapasos y 64 con un respirador volumétrico. Nuestros resultados muestran tanto una duración del ingreso en UCI y de la hospitalización como una reintegración familiar sin diferencias significativas, con tendencia a una mayor supervivencia en los pacientes con marcapasos (18,18 frente a 9,67 años por el método de Kaplan-Meier, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), aunque esta diferencia deja de ser estadísticamente significativa (p = 0,06) tras controlar los grupos por la edad. Asimismo, muestran una mejor calidad de vida en estos mismos pacientes con marcapasos en términos de seguridad, comunicación, sociabilidad, comodidad y movilidad.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">La ventilación con marcapasos diafragmático es un método alternativo a la ventilación mecánica con similar eficacia que facilita una mejor calidad de vida en los pacientes con lesión medular que requieren apoyo respiratorio permanente.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
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| 2024 November | 6 | 13 | 19 |
| 2024 October | 34 | 66 | 100 |
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