P085 Case report of direct diaphragmatic pacing in a child

Abstract Background We present the case of an 8-year-old boy who was diagnosed with acute flaccid myelitis at the age of 5 subsequent to an enterovirus infection. His course was complicated by near complete paralysis of the diaphragm and ventilatory failure necessitating tracheostomy. He has subsequently required full time ventilation via tracheostomy despite gaining sufficient motor function for walking. We describe the concept, indications, and contraindications of diaphragm pacing in ventilator-dependent paediatric populations and compare its use to similar adult populations. Methods Direct diaphragmatic pacing is an alternative to phrenic nerve pacing, and it has gained popularity in recent years. The majority of reported cases are in adults with paralysis secondary to spinal cord injury. This is a prospective interventional case report of the use of diaphragm pacing in a ventilator-dependent paediatric patient with a tracheostomy, because he represents a unique clinical scenario for this surgery, including potential sensation of the pacing. Progress to date The patient is planned for pacing surgery in August 2024. Consent has been obtained from the family to report the case, thus permitting preparation of the manuscript while plans for surgery are underway. Intended outcome and impact The expectation is that with direct diaphragmatic pacing the patient will become less dependent on mechanical ventilation, enabling him to have more freedom in his activities. If successful this intervention will provide an opportunity for future utilisation in other carefully selected cohorts, to replace mechanical ventilation and improve quality of life.