The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on September 2017. NICE is currently updating this guidance. The new guidance will be published shortly. Until then the NHS should continue to follow the recommendations outlined in the current version of the guidance. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure review and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland
Status Awaiting development
Technology type Procedure
Decision Selected
Reason for decision Anticipate the topic will be of importance to patients, carers, professionals, commissioners and the health of the public to ensure clinical benefit is realised, inequalities in use addressed, and help them make the best use of NHS resources
Process IP
ID number 746
Description The aim of intramuscular diaphragm stimulation is to make the diaphragm contract, strengthening it and allowing full or partial weaning from mechanical ventilation. This procedure needs intact phrenic nerve function and avoids the need to access the phrenic nerve through the neck or thorax, as well as reducing the risk of phrenic nerve damage. The procedure is done laparoscopically with the patient under general anaesthesia. A probe is used to identify areas of the diaphragm where minimal electrical stimulation causes maximal diaphragm contraction (known as the 'motor points'). Two intramuscular electrodes are implanted on the abdominal surface of each hemi-diaphragm at the motor points. The electrode leads are tunnelled subcutaneously to an exit site in the chest where they are connected to an external battery-powered pulse generator. A reference electrode (anode) is also implanted and the leads tunnelled with the other electrodes. Intraoperative stimulation and voltage calibration tests are done to confirm adequate contraction of the diaphragm. After implantation the patient has a diaphragm conditioning programme, which involves progressive use of the system for increasing periods of time with gradual weaning from the ventilator.

Provisional Schedule

IPAC 1 10 November 2022
Interventional procedure consultation 04 January 2023 - 01 February 2023
IPAC 2 09 March 2023
Expected publication 22 May 2023

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Key events during the development of the guidance:

Date Update
04 May 2022 Awaiting development. Status change linked to Topic Selection Decision being set to Selected

For further information on how we develop interventional procedures guidance, please see our IP manual