Rodeo Drive Institute for Breathing Surgery

People confined to a mechanical ventilator face many challenges to their quality of life and overall life expectancy. There are numerous causes for confinement to the ventilator. Many of these problems can be alleviated with the aid of surgery. One procedure uses a phrenic nerve pacemaker for treatment to free patients from the need to use a ventilator.

The Rodeo Drive Institute for Breathing Surgery uses surgery to assist people with a wide variety of breathing disorders - using treatments as varied a rhinoplasty to sinus surgery to the placement of pacemakers on the phrenic nerve.

A breathing pacemaker consists of surgically implanted receivers and electrodes and an external transmitter with antennas worn directly over the implanted receivers. Plastic surgeon Dr. Lloyd Krieger and his father neurosurgeon Dr. Abbott Krieger have developed an internationally renowned expertise in the phrenic nerve pacing surgery.

The external transmitter and antennas send radiofrequency energy to the implanted receivers just under the skin. The receivers then convert the radio waves into stimulating pulses.

These pulses are then sent down the electrodes to the phrenic nerves, causing the diaphragms to contract. This contraction causes inhalation of air. When the pulses stop, the diaphragms relax and exhalation occurs. Repetition of this series of pulses produces a normal breathing pattern.

A breathing pacemaker can provide ventilatory support for patients with chronic respiratory insufficiency whose diaphragm, lungs, and phrenic nerves have residual function. Typically, these patients have high spinal cord injuries, central sleep apnea or other central neurological disorders, or a paralyzed diaphragm. These patients are a focus of our care at our plastic surgery center.

Pacing has many advantages over positive pressure ventilation, including:

• Breathing pacemakers provide respiratory function superior to mechanical ventilators since the inhaled air is drawn into the lungs by the diaphragm under negative pressure, rather than being forced into the chest under positive pressure.
• Pacing patients are at much lower risk of ventilator-associated pneumonia (VAP) due to the reduction in suctioning, elimination of external humidifier and ventilator circuits, and the potential removal of the tracheostomy tube in appropriate patients.
• Most patients prefer pacing over mechanical ventilation for a variety of reasons including normal breathing and speech patterns, ease of eating and drinking, and its silent operation.

Diaphragm Paralysis is the loss of control of one or both hemidiaphragms caused by a traumatic injury or disease process which decreases or terminates the impulse of respiratory stimuli originating in the brain. Causes of diaphragm paralysis include, but are not limited to:

• Central neurological disorders such as a brain or brainstem stroke,
  
  
• Spinal cord disorders such as syringomyelia or poliomyelitis,
  
  
• Direct trauma to the phrenic nerve from surgery, radiation, or tumor,
  
  
• Autoimmune diseases such as multiple sclerosis,
  
  
• Demyelinating disease processes such as Guillan-Barré syndrome and ALS (Lou Gehrig's Disease),
  
  
• Phrenic nerve neuropathy, viral or bacterial infections, and unknown (ie, idiopathic) etiologies.

Drs. Lloyd Krieger and Abbott Krieger perform phrenic nerve surgery in Recife, Brazil.
They were brought to the country by Brazil's government because of their
expertise in the procedure.
Diaphragm Paralysis

Breathing pacemakers are indicated for patients with diaphragm paralysis who would otherwise be completely or partially dependent on mechanical ventilation so long as the phrenic nerve(s) and diaphragm(s) are intact. Patients with diseases in which there is progressive demyelination of the phrenic nerves (such as ALS) or weakening of the diaphragm muscle (such as muscular dystrophy) are generally poor candidates for diaphragm pacing.

Careful preoperative evaluation (phrenic nerve conduction studies, pulmonary function tests, etc.) would be indicated in all cases. Benefits of diaphragm pacing for diaphragm paralysis include:

• Improved respiratory function since the inhaled air is drawn into the lungs by the diaphragm under negative pressure, rather than being forced into the chest under positive pressure.
  
  
• Lower infection rates due to the reduction in suctioning, elimination of external humidifier and ventilator circuits, and the potential removal of the tracheostomy tube.
  
  
• Improved mobility, normalized breathing and speech patterns, ease of eating and drinking.

Rodeo Drive Plastic Surgery
421 North Rodeo Drive
Terrace Level South (Second Floor)
Beverly Hills, CA 90210
T 310 550 6300
F 310 550 6363

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Rodeo Drive Rhinoplasty provides expert rhinoplasty in California. Our plastic surgeon specializes in all nose surgery including ethnic rhinoplasty and revision rhinoplasty and rhinoplasty for men. Please contact us for more information about septoplasty, breathing surgery, snoring surgery, and Los Angeles sinus surgery. We also provide expert care for other procedures such as Los Angeles tummy tuck and Beverly Hills breast augmentation. We can help you with all of your needs for Orange County Plastic Surgery.