Ventilator-Assisted Living

Winter 2004, Vol. 18, No. 4

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The Pneumobelt: Part of My Noninvasive Ventilation System

Tedde Scharf, MA, Tempe, Arizona

I work fulltime as assistant dean at a large university and lead a full social life. The pneumobelt has made this possible because it provides hands-free assisted ventilation without any apparatus around my face. The only evidence that I use an assisted breathing device (due to limb-girdle muscular dystrophy) is the tubing around the side of my Permobile 2K wheelchair and the whooshing sound of the ventilator.

diagram of the pneumobeltThe pneumobelt, also known as an exsufflation belt, consists of an air bag or rubber bladder inside a cloth corset that is worn around the abdomen just under the diaphragm. It is connected by tubing to a ventilator that alternately inflates and deflates the bladder. As the pneumobelt inflates, it applies pressure up under the diaphragm to force air out of my lungs for exhalation. Then the bladder deflates, lowering the diaphragm, allowing air to rush back into my lungs passively for inhalation.

The ventilator settings can be set to provide a smooth, natural inhalation and exhalation, as well as a natural breathing rate for speaking. I use the LTV® 950 (Pulmonetic Systems, Inc.) to power my pneumobelt.

Because the pneumobelt works with gravity, it is only effective in the sitting and standing positions and cannot be used at night in the supine position. Other forms of noninvasive interfaces such as a face mask, a nasal mask, nasal pillows, or oral masks and mouth-seals can be used for nocturnal ventilation. I use a custom Lyon nasal mask at night.

Commercial pneumobelt "corsets" and air bladders are available through Respironics, Inc.. The air bladder can be purchased separately from Respironics, the sole manufacturer. Many pneumobelt users have custom corset casings made by prosthetic/orthotic companies because the commercial corset is not very comfortable. The narrow nylon straps can cut into your sides. I wear a cotton T-shirt under the pneumobelt with thin foam pads to prevent pressure sores on my ribs and hipbones. Dr. Scholl's gel pads for shoes work well.

Currently, I'm experimenting with a new custom pneumobelt corset that utilizes 3" wide elastic belting found in low-back support belts. Its four straps are crossed in the back, attached to a sturdy but soft fabric that wraps partway around my sides (curved wider at the bottom to fit my hips). I've used this belt for about two months, sometimes up to 16 hours a day, and it's very comfortable – no extra padding needed.

During the day, I carry around a small mouthpiece attached to a short rubber flexible tube with common ventilator connectors. When I need to transfer out of my wheelchair, I disconnect the ventilator tubing from the pneumobelt (to prevent accidentally leaning on, overcompressing or blowing a hole in the air bladder) and attach the mouthpiece to the tubing. It's important to protect the air bladder from permanent damage from too much pressure when my caregivers lean me forward during caregiving. I also use this mouth intermittent positive pressure ventilation (MPPV) while bathing, dressing and undressing. MPPV is handy when I'm tired, need a little more ventilation or want to recline to watch television.

I have learned – the hard way – to always change the ventilator settings to lower volumes when transitioning from the mouthpiece to the pneumobelt to prevent accidental over-inflation and blowing a hole in the air bladder. The newer pneumobelt air bladders are tougher and less likely to overinflate. Generally, the air bladder lasts me a year or longer and, with the standard corset, costs about $800.

I augment my breathing during the day by frog breathing (gulping air into the back of my throat and forcing it into my lungs with my tongue). I can breathe this way for about 20 to 30 minutes if I'm sitting upright. In a reclined position, it takes more effort, but it is still life-sustaining. I highly recommend learning this technique; it is invaluable when equipment breaks down and for a change between other assisted breathing methods.

In emergencies, I use an Ambu® bag (manual resuscitator) and keep one handy in my office, near my bed and always take one when traveling. I also keep backup tubing, connectors and mouthpieces readily available.

Tedde's article, "Noninvasive Ventilation: A Successful Changeover," appeared in IVUN News, Spring 1996, Vol. 10, No. 1.

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