Evaluation of Phrenic Nerve and Diaphragm Function with Peripheral Nerve Stimulation and M-Mode Ultrasonography in Potential Pediatric Phrenic Nerve or Diaphragm Pacing Candidates - 05/12/14

Doi : 10.1016/j.pmr.2014.09.010

Andrew J. Skalsky, MD ^a,^⁎ , Daniel J. Lesser, MD ^b, Craig M. McDonald, MD ^c
^a Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, 3020 Children’s Way, MC 5096, San Diego, CA 92123, USA
^b Division of Pediatric Respiratory Medicine, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, 3020 Children's Way, San Diego, CA, USA
^c Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Sacramento, CA 95817, USA

^∗Corresponding author.

Résumé

Assessing phrenic nerve function in the setting of diaphragmatic paralysis in diaphragm pacing candidates can be challenging. Traditional imaging modalities and electrodiagnostic evaluations are technically difficult. Either modality alone is not a direct measure of the function of the phrenic nerve and diaphragm unit. In this article, the authors present their method for evaluating phrenic nerve function and the resulting diaphragm function. Stimulating the phrenic nerve with transcutaneous stimulation and directly observing the resulting movement of the hemidiaphragm with M-mode ultrasonography provides quantitative data for predicting the success of advancing technologies such as phrenic nerve pacing and diaphragm pacing.

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Keywords : Pediatric, Spinal cord injury, Diaphragm pacing, Phrenic nerve pacing, Ultrasonography