Diaphragmatic pacing may be indicated in

A. idiopathic central alveolar hypoventilation.
B. neuropathy syndromes.
C. obstructive sleep apnea syndromes.
D. traumatic diaphragmatic injury.
E. tumors of the cerebral cortex.

Answer A

Diaphragmatic pacing is an accepted treatment of ventilatory support in two clinical settings: idiopathic central alveolar hypoventilation and spinal cord injury, most often quadriplegia. In both cases, injury to the spinal cord prevents transmission of stimuli to the phrenic nerves. Tumor, neuropathy, traumatic diaphragmatic injuries and obstructive apnea syndromes are not indications for pacing because either the phrenic nerve or the muscular diaphragm is dysfunctional.

Elefteriades JA, Quin J. Diaphragmatic pacing. Chest Surg Clin N Amer 1998;8:331-57.
Diaphragm pacing is an established mode of ventilation for patients with upper motor neuron injury and preserved phrenic nerve function. Careful patient evaluation with regard to phrenic nerve function, motivation, and adequate psychosocial support is paramount for successful pacing. In properly selected individuals, full-time continuous bilateral pacing for several years has been demonstrated with advantages of increased independence and productivity, fewer tracheal tube complications, and improved phonation. Ongoing research in the field of diaphragm pacing includes refinements in electrode placement and continued testing of totally implantable devices.