January 2017 – NICE is updating this guidance (see the guidance in development page for information). The NHS should continue to follow the recommendations in this guidance until the update is complete.

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure due to neurological disease.


Some patients with spinal cord injuries cannot breathe on their own and require a mechanical ventilator to assist them. Intramuscular diaphragm stimulation involves keyhole abdominal surgery (laparoscopy) to implant electrodes into the breathing muscle (diaphragm) close to its main nerve supply. Wires are connected through the skin to a battery-operated electrical stimulation system which causes the diaphragm to contract as it does in normal breathing. The aim of the procedure is to allow patients to breathe without mechanical assistance and to improve their quality of life.

Coding and clinical classification codes for this guidance.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)