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Diaphragm pacing restores olfaction in tetraplegia

¹ APHP, Service de Pneumologie et Réanimation et Centre de Stimulation Phrénique Implantée, Groupe Hospitalier Pitié-Salpêtrière, ⁴ APHP, Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, ² Université Paris 6, ER 10 UPMC, Paris, France, and ³ Service de Pneumologie, Hôpital Cantonal Universitaire de Genève, Geneva, Switzerland.

CORRESPONDENCE: T. Similowski, Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75651 Paris, Cedex 13, France. E-mail: thomas.similowski{at}psl.ap-hop-paris.fr

Keywords: Phrenic stimulation, quality of life, spinal cord injury, tracheotomy, ventilator-dependency

Received: November 23, 2008
Accepted February 3, 2009

High cervical spinal cord injuries induce extreme handicap and tactile isolation. Tracheotomised tetraplegic patients are also bound to be olfaction deprived. By restoring negative pressure inspiration, diaphragm pacing (DP) should improve olfaction.

We tested olfaction in 10 consecutive tetraplegics during positive pressure mechanical ventilation and DP, using the University of Pennsylvania Smell Identification Test (UPSIT). Quality of life was assessed using the Satisfaction with Life Scale (SWLS). Self-perceived benefits of DP were studied using an in-house questionnaire.

Olfaction was very poor during positive pressure mechanical ventilation (UPSIT, mean±SD 17.1±6.4, anosmia or severe microsmia). It improved during DP (35.2±1.9, normosmia or mild microsmia; p<0.0001) and SWLS was 18.5±4.2. Nine patients stated that DP had improved their quality of life. This was driven by better mobility (ranked first), improved self-image and relationships with others (ranked second), improved olfaction and better feeling of security (both ranked third).

Improved olfaction is among the benefits of DP and should be mentioned to patients considered for this therapy. Furthermore, attention to olfaction is warranted in tracheotomised ventilator-dependent patients, as a putative path towards improvement of quality of life.