A breathing pacemaker consists of surgically implanted receivers and electrodes and an external transmitter with antennas worn directly over the implanted receivers.
The external transmitter and antennas send radiofrequency energy to the implanted receivers just under the skin. The receivers then convert the radio waves into stimulating pulses.
These pulses are then sent down the electrodes to the phrenic nerves, causing the diaphragms to contract. This contraction causes inhalation of air. When the pulses stop, the diaphragms relax and exhalation occurs. Repetition of this series of pulses produces a normal breathing pattern.
A breathing pacemaker can provide ventilatory support for patients with chronic respiratory insufficiency whose diaphragm, lungs, and phrenic nerves have residual function. Typically, these patients have high spinal cord injuries, central sleep apnea or other central neurological disorders, or a paralyzed diaphragm.
Pacing has many advantages over PPV, including:
Breathing pacemakers provide respiratory function superior to mechanical ventilators since the inhaled air is drawn into the lungs by the diaphragm under negative pressure, rather than being forced into the chest under positive pressure. This is physiologically more accurate and comfortable for the patient.
Pacing patients are at much lower risk of upper airway infections including ventilator-associated pneumonia (VAP) due to the reduction in suctioning, elimination of external humidifier and ventilator circuits, and the potential removal of the tracheostomy tube in appropriate patients.
Breathing pacemakers are small, and do not require the bulky tubing and batteries of mechanical ventilators so the patient’s mobility is greatly enhanced.
The silent operation of a breathing pacemaker greatly enhances the patient’s ability to participate in social and educational environments.
Most patients strongly prefer pacing over mechanical ventilation for a variety of reasons such as normal breathing and speech patterns, ease of eating and drinking and improved sense of smell.
Breathing pacemakers generally cost less than $1,000 per year in disposable supplies (antennas, batteries, etc.) to operate, which is substantially less than the rental fees and disposable supplies associated with a mechanical ventilator. On average, a breathing pacemaker will pay for itself in roughly 2 years and save over $20,000 per year thereafter.
Breathing pacemakers can be implanted using a variety of minimally-invasive surgical approaches, usually through a small neck incision. For certain patients, the procedures can even be performed on an outpatient basis. For others, breathing pacemakers can be used in conjunction with intercostal or spinal accessory nerve grafting to restore diaphragm enervation and allow pacing in patients who otherwise would not be candidates.
At the Institute for Advanced Reconstruction our world renowned phrenic nerve and diaphragm pacemaker surgeons perform nerve grafts in conjunction with placement of diaphragm pacemakers for those select patients that would otherwise not be candidates for ventilator weaning procedures.