| Time to Untether Webinar: Respiratory pacing in children with tetraplegia, an alternative to positive pressure ventilation |
|
| Presented by: Janet Dean, MS, RN, CRNP |
| Pediatric Nurse Practitioner |
| Kennedy Krieger Institute |
| Assistant Professor PM&R |
| Johns Hopkins School of Medicine |
| Baltimore, MD |
|
| Tami McMichael, CPNP, AC/PC |
| Pediatric Nurse Practitioner |
| Bethany Children’s Health |
| Center in Bethany, OK |
|
| Mary Jo Elmo, APRN |
| Nurse Practitioner |
| University Hospitals Cleveland Medical Center |
| Cleveland, OH |
| Date: June 21, 2023 12pm EST |
Description: Due to anatomical and biomechanical difference, cervical spinal cord injuries occur disproportionately in 60 to 80% of children under the age of 8 years. Injuries at C3 neurologic level and above result in tetraplegia, respiratory failure, lifelong dependence on a tracheostomy and positive pressure ventilation (PPV). While PPV is lifesaving, its use is associated with significant morbidity and mortality including recurrent respiratory infection, mucous plugging, sleep disordered breathing, constant noise, and accidental disconnection or decannulation. As an alternative to PPV, a surgically implanted diaphragm pacing (DP) or phrenic nerve pacing (PN) system stimulates contraction of the diaphragm resulting in natural, negative pressure ventilation. With these systems, respirations are generated by a small, silent device, eliminating the need for bulky tubing and noisy portable ventilators. Both systems require intact phrenic nerves. In children with phrenic nerve injury, phrenic nerve transfer (PNT) has been used to reinnervate the diaphragm. |
Learning Objectives: |
| 1. Describe the unique anatomic and biomechanical difference in spinal and respiratory anatomy and physiology of children. |
| 2. Review the literature and discussed acute management and ongoing health maintenance necessary for children with spinal cord injury requiring long-term respiratory support. |
| 3. Present 3 pediatric cases illustrating the advantages of available alternatives to positive pressure ventilation including surgically implanted diaphragm pacing system (DPs), phrenic nerve stimulation system (PNs) and if needed phrenic nerve transfer (PNT). |
