Initiation of Pacing
 |
Refer to the Instruction Manual provided with each system for complete instructions on postoperative care and initiation of pacing. |
Preparation
• Insert batteries into transmitter, turn both sides ‘OFF’.
• Set amplitude dials to 0.0 on both sides.
• Secure antennas over implanted receivers and connect to transmitter.
• Preoxygenate patient as necessary.
Amplitude Determination
Each hemidiaphragm is initially evaluated independently of the other.
• Discontinue alternate method of ventilation if required.
• Turn first side ‘ON’ and slowly increase amplitude control until threshold is reached.
• Gradually increase amplitude until adding amplitude no longer increases tidal volume or diaphragm reaches maximum deflection.
• Process should be repeated for the second side, allowing for the patient to rest on an alternative means of ventilation as necessary.
• Once unilateral amplitudes are determined and the patient is sufficiently oxygenated, both sides should be turned ‘ON’ and a bilateral tidal volume measured.
• Respiratory rate should be set so that minute volume is appropriate for the patient’s clinical needs.
Diaphragm Reconditioning
|
Thresholds can vary by up to 20%, so readjustment of amplitudes may be occasionally required to maintain tidal volume and patient comfort. |
• Patients should be allowed to pace until indications of diaphragm fatigue occur. This can be observed by a 50% decrease in tidal volume, decreasing oxygen saturation, or increasing CO2 retention.
• Pacing should be resumed daily until 24 hour pacing, or desired amount, is achieved.
For patients with little or no intraoperative response, or who have undergone a nerve grafting procedure, diaphragm reconditioning should take place asynchronously with a mechanical ventilator until such time as a sufficient tidal volume is obtained.