Safety and efficacy of phrenic nerve stimulation: A case series at the University of Oklahoma and review of the international literature.

Background: The aim of this study was to evaluate outcomes of phrenic nerve stimulation (PNS) in a patient cohort, review current literature, and propose patient candidacy criteria to ensure that therapeutic effects of PNS are maximized. Methods: We conducted a retrospective chart review at a Level 1 trauma center between January 1, 2020, and October 7, 2024, to assess outcomes of pediatric and adult patients who underwent PNS implantation. To identify relevant studies on PNS, we used PubMed to conduct a literature search. Results: The cohort consisted of 10 patients with 13 PNS implantation procedures. Ages ranged from 12 to 68 years (median, 19 years). Spinal cord injury (SCI) was the most common diagnosis (n = 5, 50%). Pacing was successfully achieved in 80% (n = 8). The two patients whose PNS were not successful shared a history of neurodegenerative disease (NDD). Complications were observed in two patients. Our literature search identified 23 studies. The relevant literature showed that, on average, complete ventilation independence was achieved in 61% of patients who underwent PNS. Conclusion: PNS can be an effective method for achieving ventilator independence in carefully selected patients, particularly those with high cervical SCIs. However, its efficacy in NDDs appears limited. PNS appears to be most effective in a specific subset of individuals, which suggests that proper patient selection is a key element to the success of this procedure. While PNS shows promise, larger controlled studies are needed to establish the long-term efficacy and safety profile of this procedure across various patient populations.