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Zysman M, Chabot F, Housset B, Morelot Panzini C, Devillier P, Roche N. Pharmacological treatment optimisation for stable COPD: an endless story? Proposals from the Société de Pneumologie de Langue Française. Eur Respir J 2017; 50:50/4/1701250. [PMID: 29025880 DOI: 10.1183/13993003.01250-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/02/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Maeva Zysman
- Département de Pneumologie, Université de Lorraine, CHU de Nancy, Vandœuvre-lès-Nancy, France.,Inserm U955, Team 04, Créteil, France
| | - François Chabot
- Département de Pneumologie, Université de Lorraine, CHU de Nancy, Vandœuvre-lès-Nancy, France
| | - Bruno Housset
- Service de Pneumologie, UPEC, Université Paris-Est, UMR S955, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Capucine Morelot Panzini
- Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière Charles-Foix, Inserm, Université Pierre-et-Marie-Curie, UMRS 1158, Paris, France
| | - Philippe Devillier
- UPRES EA 220, Département des Maladies des Voies Respiratoires, Hôpital Foch, Université Versailles-Saint-Quentin, Suresnes, France
| | - Nicolas Roche
- Service de Pneumologie, Hôpital Cochin, AP-HP, EA2511, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Abstract
Diaphragm pacing (DP) is an orphan surgical procedure that may be proposed in strictly selected ventilator-dependent patients to get an active diaphragm contraction. The goal is to wean from mechanical ventilation (MV) and restore permanent efficient breathing. The two validated indications, despite the lack of randomised control trials, concern patients with high-level spinal cord injuries (SCI) and central hypoventilation syndromes (CHS). To date, two different techniques exist. The first, intrathoracic diaphragm pacing (IT-DP), based on a radiofrequency method, in which the electrodes are directly placed around the phrenic nerve. The second, intraperitoneal diaphragm pacing (IP-DP) uses intradiaphragmatic electrodes implanted through laparoscopy. In both techniques, the phrenic nerves must be intact and diaphragm reconditioning is always required after implantation. No perioperative mortality has been reported and ventilator-weaning rate is about 72% to 96% in both techniques. Improvement of quality of life, by restoring a more physiological breathing, has been almost constant in patients that could be weaned. Failure or delay in recovery of effective diaphragm contractions could be due to irreversible amyotrophy or chest wall damage. Recent works have evaluated the interest of IP-DP in amyotrophic lateral sclerosis (ALS). After some short series were reported in the literature, the only multicentric randomized study including 74 ALS patients was prematurely stopped because of excessive mortality in paced patients. Then, another trial analysed the place of IP-DP in peripheral diaphragm dysfunction but, given the multiple biases, the published results cannot validate that indication. Reviewing all available literature as in our experience, shows that DP is an effective method to wean selected patients dependent on ventilator and improve their daily life. Other potential indications will have to be evaluated by randomised control trials.
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Affiliation(s)
- Francoise Le Pimpec-Barthes
- 1 Department of Thoracic Surgery and Lung Transplantation, Assistance Publique-Hôpitaux de Paris, Hopital Europeen Georges Pompidou, Paris, France ; 2 Université Paris Descartes, Faculté de Médecine, Paris, France ; 3 Department of Anesthesiology and Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France ; 4 Department of Respiratory and Intensive Medicine Unit, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Antoine Legras
- 1 Department of Thoracic Surgery and Lung Transplantation, Assistance Publique-Hôpitaux de Paris, Hopital Europeen Georges Pompidou, Paris, France ; 2 Université Paris Descartes, Faculté de Médecine, Paris, France ; 3 Department of Anesthesiology and Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France ; 4 Department of Respiratory and Intensive Medicine Unit, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Alex Arame
- 1 Department of Thoracic Surgery and Lung Transplantation, Assistance Publique-Hôpitaux de Paris, Hopital Europeen Georges Pompidou, Paris, France ; 2 Université Paris Descartes, Faculté de Médecine, Paris, France ; 3 Department of Anesthesiology and Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France ; 4 Department of Respiratory and Intensive Medicine Unit, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Ciprian Pricopi
- 1 Department of Thoracic Surgery and Lung Transplantation, Assistance Publique-Hôpitaux de Paris, Hopital Europeen Georges Pompidou, Paris, France ; 2 Université Paris Descartes, Faculté de Médecine, Paris, France ; 3 Department of Anesthesiology and Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France ; 4 Department of Respiratory and Intensive Medicine Unit, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jean-Claude Boucherie
- 1 Department of Thoracic Surgery and Lung Transplantation, Assistance Publique-Hôpitaux de Paris, Hopital Europeen Georges Pompidou, Paris, France ; 2 Université Paris Descartes, Faculté de Médecine, Paris, France ; 3 Department of Anesthesiology and Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France ; 4 Department of Respiratory and Intensive Medicine Unit, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Alain Badia
- 1 Department of Thoracic Surgery and Lung Transplantation, Assistance Publique-Hôpitaux de Paris, Hopital Europeen Georges Pompidou, Paris, France ; 2 Université Paris Descartes, Faculté de Médecine, Paris, France ; 3 Department of Anesthesiology and Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France ; 4 Department of Respiratory and Intensive Medicine Unit, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Capucine Morelot Panzini
- 1 Department of Thoracic Surgery and Lung Transplantation, Assistance Publique-Hôpitaux de Paris, Hopital Europeen Georges Pompidou, Paris, France ; 2 Université Paris Descartes, Faculté de Médecine, Paris, France ; 3 Department of Anesthesiology and Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France ; 4 Department of Respiratory and Intensive Medicine Unit, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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