Atrotech Atrostim PNS Anwenderhandbuch Seite 58

Atrostim PNS
4 CONDITIONING PLAN
Patients are classified in two categories:
- category A: Patients with RMP.
- category B: Patients with CAH.
Patients with RMP
The following regimen was developed for the conditioning period in adult patients
with RMP and well preserved peripheral nerve and a time of disuse of the diaphragm
of up to twelve months, see procedural flow chart 1.
We suggest the following (ideal) conditioning scheme be adhered to:
Conditioning is begun with about 2/3 of the time which had elapsed up to the start of
carbon dioxide retention, the "tolerable stimulation time". The patient is stimulated
for this time every hour preferable 24 hours a day.
A protocol for daily conditioning is shown in Form 4 (Appendix 7). Practically, 12 to
16 hours may be achieved. After one week or a shorter period it is determined again
at which duration of stimulation fatigue occurs. A regimen with the new tolerable
time is instituted for the next week. The programme continues in this manner until
full-time stimulation during 12 hours of day-time is achieved.
After a pause of two hours in the evening, full-time stimulation is begun during night
and continued during the following morning. The time of stimulation is extended one
hour each day with earlier beginning of stimulation in the evening. This is to keep
the phase at which fatigue may occur in the well-staffed hours. The patient should be
watched carefully for any signs of fatigue. If in doubt, intermittent tidal volume
measurements, blood gas analysis or capnography are used.
CAH patients
Follow the procedural flow chart 2.
Pediatric patients
Follow the procedural flow chart 1 (RMP) or procedural flow chart 2 (CAH).
April 2002
Training procedure and follow-up
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