Uso do marcapasso diafragmático em desordens respiratórias: uma revisão sistemática

Uso do marcapasso diafragmático em desordens respiratórias: uma revisão sistemática

• Autor
• Denise Fernandes de Morais
• Co-autores
• Ana Paula Rocha Brito , Augusto Sampaio Gonçalves Porto , Lucca Feitosa Esmeraldo , Raimundo Coêlho Bezerra de Farias Neto , Milena Silva Costa
• Resumo

• Use of the diaphragmatic pacemaker in respiratory disorders: a systematic review

  Considering the treatment need in pathologies that evolve to a respiratory failure, as in cervical spine traumas, Amyotrophic Lateral Sclerosis (ALS), and Central Congenital Hypoventilation Syndrom (CCHS), a variety of studies seek diaphragmatic pacemaker use evidences to replace mecanical ventilation, or even postpone the need for its use. The objective was to discuss possible benefits and harms of the equipment in relation to these diseases. This is a sistematic review through eletronic search in PubMed and Biblioteca Virtual de Saúde (BVS) database. The keywords ''diaphragmatic pacemaker'' or ''diaphragmatic pacing'' and ''hypoventilation'' or ''quadriplegia'' were used, acording to Preferred Items for Systematic Review and Meta-Analyses methodology. In eight researched articles it was possible to identify data from 184 patients and the effects of diaphragmatic pacemaker were evaluated in pathologies that cause hypoventilation. In general, ALS patients (127) showed more mortality (76%), twice the amount of adverse effects, and a shorter survival time (47.8%)  in relation to patients who were submitted only to non-invasive ventilation.  CCHS group (33) presented an average of 10h / day without mechanical ventilator, but cases of Obstructive Sleep Apnea were observed as a result of stimulation. In cases of cervical trauma (14), there was a decrease, in 57% of patients, of approximately 25% in dependence on the mechanical ventilator, and two patients recovered voluntary ventilation. Besides that, current respiratory volume levels in 12 patients undergoing implantation to study the feasibility of reducing mechanical ventilation increased by 37%, showing a reduction in diaphragmatic atrophy. It is concluded that the use of DP in patients with ALS has shown negative results in relation to mortality, expectation and quality of life. In cases of CCHS and cervical trauma, its use has been shown to be safe and effective, helping to improve respiratory capacity and quality of life of these patients. 

  Keywords: Diaphragmatic Pacemaker, Hypoventilation, Amyotrophic Lateral Sclerosis, Congenital Central Hypoventilation Syndrome and Tetraplegia.

• Palavras-chave
• Marcapasso Diafragmático, Hipoventilação, Esclerose Lateral Amiotrófica, Síndrome da Hipoventilação Central Congênita e Tetraplegia.
• Área Temática
• Gestão, Qualidade e Tecnologias de Atenção à Saúde

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