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Diaphragm pacing


Diaphragm pacing, also known as phrenic nerve pacing (and even earlier as electrophrenic respiration), is the rhythmic application of electrical impulses to the diaphragm to provide ventilatory support for respiratory failure or sleep apnea. Historically, this has been accomplished through the electrical stimulation of a phrenic nerve by an implanted receiver/electrode, though today an alternate option of attaching percutaneous wires to the diaphragm exists.

The idea of stimulating the diaphragm through the phrenic nerve was first firmly postulated by German physician Christoph Wilhelm Hufeland, who in 1783 proposed that such a technique could be applied as a treatment for asphyxia. French neurologist Duchenne de Boulogne made a similar proposal in 1855, though neither of them tested it. It wasn't until a year later that Hugo Wilhelm von Ziemssen demonstrated diaphragm pacing on a 27-year-old woman asphyxiated on charcoal fumes by rhythmically faradizing her phrenic nerves, saving her life. Duchenne would later in 1872 declare the technique the "best means of imitating natural respiration." However, advances in mechanical ventilation by the likes of George Poe in the early twentieth century ended up being initially favored over phrenic nerve stimulation.

Harvard researchers Sarnoff et al. revisited diaphragm pacing via the phrenic nerve in 1948, publishing their experimental results on dogs. In a separate publication a few days before, the same group also revealed they had an opportunity to use the technique "on a five-year-old boy with complete respiratory paralysis following rupture of a cerebral aneurysm." Referring to the process as "electrophrenic respiration", Sarnoff was able to artificially respirate the young boy for 52 hours. The technology behind diaphragm pacing was advanced further in 1968 with the publication of doctors John P. Judson and William W. L. Glenn's research on the use of radio-frequency transmission to at whim "adjust the amplitude of stimulation, and to control the rate of stimulation externally." Teaming up with Avery Laboratories, Glenn brought his prototype device to commercial market in the early 1970s.


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