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Vol. 35. Núm. 1.
Páginas 13-21 (enero 2010)
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Vol. 35. Núm. 1.
Páginas 13-21 (enero 2010)
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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
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1301
F.J. Romero-Ganuza
Autor para correspondencia
fjromero@sescam.jccm.es

Corresponding author.
, 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
UCI y Unidad de Cuidados Intermedios Respiratorios, Hospital Nacional de Parapléjicos de Toledo, Toledo, Spain
Este artículo ha recibido
Información del artículo
Abstract
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 qualify 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 the 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.

Keywords:
Spinal cord injuries
Artificial respiration
Diaphragmatic pacemaker
Survival analysis
Quality of life
Resumen
Objetivo

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.

Diseño

Análisis retrospectivo de una base de datos prospectiva y de tipo caso-control apareado por edad.

Ámbito

Unidad de Cuidados Intensivos y Unidad de Cuidados Intermedios Respiratorios del Hospital Nacional de Parapléjicos de Toledo.

Pacientes

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.

Intervenciones

Cuestionario de calidad de vida.

Variables de interés

Datos demográficos y clínicos, estancia hospitalaria, mortalidad, readaptación familiar y calidad de vida relacionada con la salud.

Resultados

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<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.

Conclusiones

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.

Palabras clave:
Lesión medular cervical
Ventilación mecánica
Marcapasos diafragmático
Supervivencia
Calidad de vida
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