Phrenic nerve stimulation in tetraplegia. A new regimen to condition the diaphragm for full-time respiration.

Unipolar phrenic nerve stimulation (diaphragm pacing) has been used for ventilation of patients with C2 tetraplegia. Four-pole sequential nerve stimulation delays muscle fatigue when compared with unipolar stimulation. This may help to achieve more frequently long-term full-time bilateral electroventilation. Four-pole sequential nerve stimulation also offers an opportunity to shorten the conditioning phase of the hypotrophic diaphragm from about 6 to 2 months. The new conditioning regimen was tested successfully in two patients with C2 tetraplegia. The new stimulation method and conditioning regimen remarkably shorten the time after injury during which mechanical ventilation is needed. This will give the patients earlier access to rehabilitation centres for spinal cord injuries and will diminish the work load of the personnel.