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• W1999946520 abstract "Dr Gay1Gay PC Counterpoint: should phrenic nerve stimulation be the treatment of choice for spinal cord injury? No.Chest. 2013; 143: 1203-1206Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar has shared some interesting points. Many of his arguments hinge on the assumption that all patients with tracheostomy and spinal cord injury (SCI) have the option of using an alternative to either mechanical ventilation or diaphragm pacing support (DPS). This alternative would be noninvasive ventilation (NIV) and aggressive airway clearance, including mechanical cough assist. In reality, those patients with SCI who do not require invasive mechanical ventilation are not even considered candidates for DPS. If even 4 h of spontaneous breathing is possible, DPS is excluded,2Blue Cross Blue Shield Blue Care Network of Michigan Phrenic nerve/diaphragm pacing. Blue Cross Blue Shield of Michigan website.http://www.bcbsm.com/mprApp/MedicalPolicyDocument?fileId=2047509Google Scholar and 24-h NIV when there is no use of hands is possible but may not be practical. Dr Gay1Gay PC Counterpoint: should phrenic nerve stimulation be the treatment of choice for spinal cord injury? No.Chest. 2013; 143: 1203-1206Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar also states that mechanical ventilation with a Passy-Muir valve (Passy-Muir Inc) provides completely normal speech, but the use of a Passy-Muir valve may not be safe in all patients because of secretions that may obstruct the valve, and speech without the valve is unnatural because it occurs mainly during inhalation. In addition, many patients have an intolerance to the added resistance of the Passy-Muir valve, and fenestrated tubes are not an adequate compensation because they may promote aggressive leak compensation, even risking respiratory alkalosis and seizure. In the best of situations, leak speech using mechanical ventilation does not produce adequate speech.3MacBean N Ward E Murdoch B et al.Optimizing speech production in the ventilator-assisted individual following cervical spinal cord injury: a preliminary investigation.Int J Lang Commun Disord. 2009; 44: 382-393Crossref PubMed Scopus (15) Google Scholar Many of Dr Gay's points do not appropriately balance the risks. Device failure is an issue with both DPS and mechanical ventilation, but given that the battery life for a pacer is 500 h4Synapse Biomedical Inc Frequently asked questions (FAQs). Synapse Biomedical Inc website.http://www.synapsebiomedical.com/images/FAQ613.pdfGoogle Scholar compared with the very common occurrence of disconnection or the insurmountable fear of electrical power outage, this comparison easily favors the DPS system. One patient's rhinosinusitis cannot serve as a reason to deny all patients the ability to smell. One assertion that large tidal volumes cause aspiration is in contradiction to other data showing that lung volume recruitment improves the ability to swallow.5Wheeler Hegland KM Huber JE Pitts T Sapienza CM Lung volume during swallowing: single bolus swallows in healthy young adults.J Speech Lang Hear Res. 2009; 52: 178-187Crossref PubMed Scopus (31) Google Scholar Finally, it is important to remember that everyone would be in favor of a large North American trial for the DPS system, but Dr Gay's allusion to the National Emphysema Treatment Trial is flawed. That trial's final recommendation was to refer these many patients who do not benefit from lung volume reduction surgery for the more-expensive lung transplantation.6Criner GJ Cordova F Sternberg AL Martinez FJ The National Emphysema Treatment Trial (NETT) part II: lessons learned about lung volume reduction surgery.Am J Respir Crit Care Med. 2011; 184: 881-893Crossref PubMed Scopus (144) Google Scholar The final global cost advantage comes only from the reality of a fixed number of organs, leaving most patients untreated. In the setting of SCI, all patients will receive either mechanical ventilation or pacing. No one will be left untreated. We cannot hide from the costs in both dollars and quality of life. All of these patients will need to decide: ventilation or pacing? But will they all be offered the choice?" @default.
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• W1999946520 date "2013-05-01" @default.
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• W1999946520 title "Rebuttal From Dr Wolfe" @default.
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• W1999946520 doi "https://doi.org/10.1378/chest.13-0218" @default.
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