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Nomination «For creation of new treatment method» in «Doctor of the year 2011» competition

«Experience of using diaphragmatic stimulator as alternative to traditional MV in case of respiratory ventilation failure».

Behind the title of this article for a medical congress there is great desire to help sick children in a seemingly hopeless situation. But staff of the center - Sergei Ivanovich Sirota, Marina Iurevna Kafanova, Evgenii Vladimirovich Polovnikov - have found the way out . In 2006 the hospital have admitted two kids in interval of six months. Both got medulla oblongata injuried in car accidents, and they could not breathe on their own. So, lifes of these children was narrowed to the size of the intensive care ward. Because mechanical ventilation device had to breathe for them. And lifelong substitution of respiratory function was the only indication for staying them in intensive care.

What to do? This question was for parents, which could not accept the fact that intensive care became home for their children, and for doctors. Discharging of such patient is impossible. Child spend a lot of time in the intensive care, which leads to blockage of intensive care bed and expensive MV (mechanical ventilation) device, also they require high quality care. Every tenth hospital patient stay in intensive care department every year. And these children become a source of accumulation of multi-resistant flora that can adversely affect sanitary-epidemiological conditions in the intensive care department. Finding a way out from this situation got some result.

It turned out that one of the American companies produces a diaphragmatic/phrenic stimulators for 20 years, which are alternative to MV devices in such situations. There is a fifteen years of experience of using these stimulators. Effectiveness of devices already proved on more than a thousand patients, including children. The method is in installation of the electrodes to the phrenic nerve in neck or thorax, and their electrical stimulation with pulses of certain force and speed.

Since up to 80% of work in inhaling is done by diaphragm muscle, that is enough to provide ventilation and oxygenation of blood. But at that time this device had no registration on Russia territory. So doctors didn't have right to use it. Besides, the cost of this device is about 2.5 million rubles. But to give up when you know that you can help...

Charity fund was found, which helped to register the device in Russia and to send doctors in Germany for studying. And then paid for the device. First patient to whom the device was installed, have been lying in intensive care for 3 years - from 3 to 6 years old. Patient is at home for two years now. Even finishes studying first year at school.

Then there was second patient. Overall, during last 3 years there was five children aged from 3 to 14 years whom diaphragmatic stimulators was successfully installed, they have been lying in the intensive care for 2-4 years. Two patients had confirmed Ondine's curse syndrome and demanded replacement of respiratory function only in sleeping time, three patients had a traumatic injury of brainstem and cervical region of spinal cord at C1-2, they constantly were on MV.

Surgeries of electrodes installation on phrenic nerve with cervical access were done to all of them. One month of electrodes implantation surgery, rehabilitation of the diaphragm muscles was made. It was adequate nutritional support of gradually loading of phrenic nerve with electrical stimulation. There was selection of electric charge power, which corresponded to the amplitude of diaphragm movement, and time and frequency of pulses, which corresponded to frequency of breathing.

Stimulation of phrenic nerves was performed until diaphragm muscle became weary, it was controlled by the breath volume, blood oxygen saturation level, capnometry. Children were able to breathe atmospheric air within 24 hours, it was achieved within a month by increasing the time spent on phrenic stimulator. All children were discharged to their homes within 2.5-3 months after operation.

According to chief physician, main thing for them was that children had gone home. Certainly, they are not cured. But they got more comfortable quality of life. Head of department adds that this method is more physiological compared to traditional MV. Device has small size, self-powered, and it is easy to manage, it accomplishes patient's mobility, they even have opportunity to travel and have a normal life.

The device is easy to manage, relatives can be quickly studied to manage it. Company that produces this device, calculated that device pays for itself within 2-3 months of operation. In our case - for about half of year. And there are children who are in need of such devices. They are few, but they exist. They can be helped, if some charity fund will be found.

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Nomination «For creation of new treatment method» in «Doctor of the year 2011» competition