Advantages of Diaphragm Pacing Systems over Positive Pressure Ventilation (PPV)
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 thereby greatly improving the patient’s mobility. The silent operation of a diaphragm pacing system 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 diaphragm pacing system will pay for itself in roughly two years and save over $20,000 per year thereafter.
Receivers and Electrodes
Mark IV Transmitter
Advantages of Avery Diaphragm Pacing Systems over other Diaphragm Pacing Systems
While all methods to pace the diaphragm share certain similarities, the Avery Diaphragm Pacing System System is the only device with full premarket approval from the FDA. Additionally, it has several distinct advantages, including : Breathing pacemakers use small implanted radiofrequency receivers to receive breathing pattern signals across the patient’s intact skin. Other systems use percutaneous electrode wires that pass directly through the skin that are at constant risk for infection and present ongoing wound care management issues. Additionally, such wires provide an electrical conduction path from outside to inside the body. Accidental contact between a percutaneous lead and other conductive elements could cause tissue damage or other injury.
The implanted electrodes use a compact, single contact design which stimulates the entire phrenic nerve at once, rather than multiple contact designs which can be surgically difficult to place and are subject to additional potential failure points. Because of this design, Avery diaphragm pacing systems can be implanted using a variety of minimally-invasive surgical approaches including cervical and thoracoscopic techniques.
For certain patients, the procedures can even be performed on an outpatient basis. For others, diaphragm pacing systems 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.
The surgeon does not need specialized training in order to implant an Avery system, and no specialized equipment is required. Onsite technical assistance is provided at each surgery at no additional cost.
Avery diaphragm pacing systems are designed with bilateral redundancy for superior safety. Each diaphragm is paced by its own receiver, electrode, and external transmitter output. This independence provides an extra margin of safety as there is no single failure point which could cause the entire system to stop working. These devices have also been subject to rigorous environmental and electromagnetic testing by independent laboratories to ensure safety and efficacy.
Unlike other systems, the Avery transmitter is entirely self-contained and does not require a complicated external programmer to configure it. End user controls allow patients and their caregivers the flexibility to adjust the system as needed. They also use standard alkaline batteries which are readily available worldwide.
Avery diaphragm pacing systems are not contraindicated for patients with cardiac pacemakers or other implanted medical devices.
Avery has been commercially distributing diaphragm pacing systems since the early 1970’s. Since then, nearly 2000 patients have been implanted in over 40 countries establishing an unsurpassed record of safety and reliability.
Dependent on the patient’s age and geographic location, Avery can provide a referral to an experienced center.