Atrotech Atrostim PNS Anwenderhandbuch Seite 57

Training procedure and follow-up Atrostim PNS
Repeat steps 5 - 8 with the other combinations, and on the right side.
When finished all steps, set the "Threshold select" switches on each side to "0"
position. Set minimum and maximum pulse interval (PI) to 45 ms and 55 ms
respectively, and PI SLOPE to 60 % ID (inspiration duration). Turn off the controller
or disconnect the coils from the controller.
3 EVALUATION OF DIAPHRAGM FORCE AND FATIGUE RESISTANCE
The following tests determine the basic level for training. If the force of the diaphragm
is sufficient to cause an adequate tidal volume, conditioning can be performed without
mechanical ventilatory support. The fatigue test determines the upper limit for the
individual stimulation period in the beginning of the conditioning period.
Electrophrenic respiration should not be started before healing of wounds is complete,
see above. Min PI and max PI are adjusted around the initial value. The preset values
for PI are 45 ms and 55 ms, respectively. With these values slight vibrations may be
felt during contraction of the diaphragm. Minimum PI must not be adjusted below 40
ms. TV currents are adjusted according to the respiratory need by decreasing current
values in all combinations. This is achieved by aid of the setting "VOLUME" of the
controller. This setting reduces I in all combinations by the same amount in relation
TV
to their initial individual value. "VOLUME" setting has three preset values, "LOW",
"NORMAL" and "HIGH" whose actual percentage values can be adjusted separately.
RR and inspiration duration have to be tried out for each patient empirically during
several periods of about 5 minutes duration. Use Form 3 (Appendix 6) to record all
parameter values.
When p CO remains stable over 5 minutes, and the patient also feels comfortable, a
ET 2
pause of about half an hour should be kept. After that pause the stimulator is used for
ventilation until the patient notices symptoms of carbon dioxide retention, or a rise of
p CO is seen. This is a manifestation of muscle fatigue, which may be seen after 20 -
ET 2
40 minutes.
4
April 2002