Intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure from high spinal cord injuries

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 6 sources, which was discussed by the committee. The evidence included 1 prospective single-arm trial and meta-analysis of 5 studies, 3 retrospective case series, 1 systematic review and 1 case report. It is presented in the summary of key evidence section in the overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: improved quality of life and number of ventilator-free hours.

The professional experts and the committee considered the key safety outcomes to be: pain, pneumonia, electrode insertion site infection, electrode breakage, device failure and survival.

Patient commentary was sought but none was received.

The committee noted that the procedure can interfere with cardiac pacemakers.

The committee was informed that the device currently used for this procedure is not MRI compatible.

The committee noted that this procedure is likely to be suitable for only a small number of people.