PT  - JOURNAL ARTICLE
AU  - Tunc Lacin
AU  - Pinar Kahraman Koytak
AU  - Canan Cimsit
AU  - Nuri Cagatay Cimsit
AU  - Emel Eryuksel
AU  - Hakan Gunduz
AU  - Kayihan Uluc
AU  - Sait Karakurt
AU  - Berrin Ceyhan
AU  - Tulin Tanridag
AU  - Mustafa Yuksel
TI  - Diaphragm pacing improves survival in a select group of amyotrophic lateral sclerosis
AID  - 10.1183/1393003.congress-2017.PA2196
DP  - 2017 Sep 01
TA  - European Respiratory Journal
PG  - PA2196
VI  - 50
IP  - suppl 61
4099  - http://erj.ersjournals.com/content/50/suppl_61/PA2196.short
4100  - http://erj.ersjournals.com/content/50/suppl_61/PA2196.full
SO  - Eur Respir J2017 Sep 01; 50
AB  - Introduction: Respiratory insufficiency in amyotrophic lateral sclerosis (ALS)patients is treated by NIMV.Objectives: In select ALS patients we aim to treat respiratory insufficiency via diaphragm pacing.Methods: Between April 2014 and December 2016, we prospectively collected data of 10 ALS patients (6 females, median age 59)who underwent diaphragm pacing and 15 ALS-matched patients who did not. In pacing group, 1 patient had trachestomy, 4 were using BIPAP. In the non-pacing group 1 patient had tracheostomy, 2 were using BIPAP. Patients who were diagnosed to have chronic hypoventilation(FVC<50%, pCO2≥45mmHg) were checked for diaphragm stimulatability by diaphragm EMG and diaphragm ultrasound. Diaphragm electrodes were inserted laparoscopically. The pacing intervals were set according to the patients’ need.Follow-ups were performed using diaphragm ultrasound.Results: Morbidity was 10%(n=1, pneumothorax) in pacing group.30-day mortality was 0% and 90-day mortality was 10%(n=1).In acute period, patients had better sleep cycles. The patient with tracheostomy was off the ventilator at the end of the 3rd month. During the follow-up two patients underwent tracheostomy, one due to excessive salivation and one due to respiratory insufficiency. None of the patients had pneumonia in the first 12 month period. Average follow-up of patients was 20.4 months (range, 3-32 months) after implantation. Diaphragmatic thickness calculated by diaphragm ultrasound showed an average of 23% increase in the thickness at the 3rd month post-implant. While the survival was 80% in the pacing group, survival was 0% in the non-pacing group.Conclusion: Diaphragm pacing improves survival in a select group of ALS patients with chronic hypoventilation.