Ventilator-Assisted Living

Summer 2001, Vol. 15, No. 2

ISSN 1066-534X

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Read selected articles from this issue ...

Camping with a Ventilator
Connie Panzarino, Massachusetts

New Diaphragm Pacing System

Respiratory Health Checklist
Linda Bieniek, CEAP, Illinois

Italian Ventilator User Survey
Liana Garini, Italy

Home Mechanical Ventilation Conference, Lyon, France, 2001
Barbara Rogers, Anthony Giles-Peters, Frank Hall-Bentick, Linda Bieniek

Percutaneous Tracheostomy: My Choice
Steve Fowler

Update: Inspiratory Muscle Training Study

Potpourri: GINI Research Fund Call for Proposals;
The Department of Health and Human Services (HHS) grants


Book: With Every Breath I Take, by Gary McPherson (

Interfaces and Equipment:
CPAP/Pro®, Total™ face mask from Respironics, Creative adaptation of Breeze™ SleepGear™,
The Newport HT50® from Newport Medical Instruments

New Diaphragm Pacing System

Anthony F. DiMarco, MD, pulmonologist and professor of physiology at Case Western Reserve University (CWRU), is the principle investigator for the research project "Electrical Activation of the Diaphragm for Ventilatory Assist." The purpose of the project is to provide full-time artificial ventilation for those individuals who use ventilators as a result of spinal cord injury (above C5).

J. Thomas Mortimer, PhD, professor of biomedical engineering at CWRU, and his team designed a diaphragm pacing system that uses intramuscular electrodes placed (through a laparoscopic procedure) within the diaphragm muscle to electrically activate the phrenic nerves. They also developed instruments to first locate the phrenic nerve motor points, and then to safely implant the electrodes at these sites.

Laparoscopy is usually performed as outpatient surgery, but the first patient was kept overnight to monitor his pulmonary status.

Dr. DiMarco noted increases in tidal volumes and vital capacity over 13 days as a result of the reconditioning process.

This pacing system has significant advantages over currently available techniques such as Avery/Dobelle and Atrostim. There is reduced risk of phrenic nerve injury because the electrodes are not placed directly on the phrenic nerve, and the system requires less time to implant due to a minimally invasive procedure, thus making it also less expensive.

Currently, the system is an external one. The wires from the electrodes are tunneled through the skin, exiting in the area below the right shoulder and stabilized with a patch. There is a cable that connects to the wires and subsequently attaches to a stimulator, which can be kept in a fanny pack or portable CD case.

The project is funded by the FDA. One person has successfully received the new pacing system and has achieved 24-hour pacing for several weeks, during which he was ventilator-free. Potential candidates must be 16 years of age, mentally alert, and have a good support system at home.

The advantages of diaphragm pacing include possible elimination of the need for mechanical ventilation, improved vocalization and sense of smell, easier transferring, and enhancement of overall quality of life.

"Phrenic Nerve Pacing" appeared in IVUN News, Spring, 1999.

Respiratory Health Checklist

Linda Bieniek, CEAP and noninvasive ventilator user in the Chicago area, developed a checklist, "Managing Chronic Respiratory Conditions," in preparation for her presentation at the 2001 Home Mechanical Ventilation Conference in Lyon on the panel "Staying Healthy: Communicating with health professionals, maintaining general health and nutrition."

The checklist is divided into three columns labeled Need, Assessment, and Action Plan. It is a useful tool to help ventilator users to monitor their respiratory status and to be alert for problems with breathing, respiratory infections, and masks, as well as nutritional needs or dietary habits that might be contributing to respiratory problems, such as alcohol intake, caffeine, etc. The sections on weight management and a healthy home environment are also helpful.

The checklist is available free through IVUN (

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