Understanding Ventilator Dependency

Respiratory failure can be a fatal emergency. Ventilators are used to move air in and out of a patient's lungs when lung capacity decreases or stops altogether. A respiratory therapist and doctor can determine how much breathing assistance a ventilator provides. Ventilators may be used for a short period of time (e.g., to help control your breathing during surgery) or for long-term use. Long-term ventilator use may be seen with obesity-hypoventilation syndrome (OHS), chronic obstructive pulmonary diseases (COPD), and neuromuscular and chest wall diseases (CWD).

When a patient is on a ventilator, they are unable to speak or eat because of the tube inserted into their throat. While the ventilator does not cause a patient pain, the tube can cause some general discomfort, like coughing and gagging.

In most cases, ventilators are life-saving. Once a ventilator is no longer needed, doctors will "wean" a patient off of the machine, slowly decreasing ventilator support until a patient can breathe on their own. If a patient is unable to wean off a ventilator and breathe independently, they become ventilator dependent. Chronic ventilator dependence is a serious medical condition that can be extremely risky for patients to overcome.

One of the most likely causes of ventilator dependency is ventilator-induced diaphragmatic dysfunction (VIDD). In other words, the diaphragm, the body’s main respiratory muscle, experiences a traumatic reduction in contractile and muscle force capacity when receiving ventilator support. 

Several lifestyle factors can put patients at greater risk of becoming ventilator-dependent. These factors included age, cause of ventilation, pre-existing medical conditions, and if previous home mechanical ventilation had been used.

Ventilator dependence increases the risks of ventilator side effects, such as:

• Infections: including pneumonia.
• Atelectasis: a condition where your lung(s) do not fully expand, causing collapsed air sacs and reduced oxygen in your blood.
• Blood clots and skin trauma: includes pressure sores (bed sores) from lying in one position for an extended amount of time.
• Pulmonary edema: a buildup of fluid in the air sacs inside your lungs.
• Lung damage: excessive oxygen or too much pressure pushing air into the lungs can cause damage and infection.
• Damaged vocal cord: a ventilator breathing tube can damage vocal cords.
• Weakened diaphragm: long-term ventilator use can create issues with a weakened diaphragm and other muscles used for breathing.

Patients with ventilator dependency have a couple of treatment options from which to choose. One of the most effective treatments is phrenic nerve stimulation.

Phrenic Nerve Stimulation

Phrenic nerve stimulation (also referred to as diaphragm pacing) is a groundbreaking approach to circumventing ventilator dependency. The phrenic nerve is located in the neck area and plays a vital role in controlling respiration. It’s the nerve responsible for signaling your diaphragm to contract and expand, which is what allows oxygen to enter and be released. With phrenic nerve stimulation, this nerve is manually stimulated to restart natural diaphragmatic contractions.

Phrenic nerve stimulation works by sending stimulating pulses down electrodes implanted into the body. These pulses are delivered directly to the phrenic nerves, signaling the diaphragm to contract, resulting in a normal pattern of breathing.

To achieve this result, a surgeon will implant an electrode right behind the phrenic nerve, either in the chest or neck area, as well as a radiofrequency receiver. The electrode and the receiver then connect to one another, and back to the phrenic nerve stimulator.

Phrenic nerve stimulation surgery takes about two to four hours to complete. Those who undergo phrenic nerve stimulation surgery after being placed on a ventilator will stay in the hospital another couple of days. Recovery from phrenic nerve surgery for ventilator dependency requires nerve regeneration, which can take 12-18 months to achieve. Your doctor is also likely to recommend diaphragm rehabilitation therapy beginning four to six weeks after surgery. Your doctor will prescribe follow-up visits to monitor your recovery over the 12 months following your surgery.

The Institute for Advanced Reconstruction participates in a wide range of insurance plans, including those listed below. However, each physician has their own accepted insurance and hospital affiliations. Before scheduling an appointment, please contact your insurance carrier to confirm that your provider is in-network.

If we are not an in-network provider, our friendly insurance specialists will help you find the most coverage available for your treatment. 

• Horizon Blue Cross Blue Shield of New Jersey
• Medicare
• Railroad Medicare
• Aetna
• Cigna
• United Healthcare
• Oxford (Freedom, Liberty)
• MagnaCare

Visit our resource page for patient forms, information specific to ventilator dependency, and more. 

If the phrenic nerve is still intact and your loved one suffers from complete or partial insufficiency due to ventilator support, they may be a candidate for our advanced phrenic nerve stimulation treatment. Schedule an appointment today to find out.