Conditioning

Conditioning is the process of increasing diaphragm muscle strength. The more the diaphragm is conditioned, the stronger the diaphragm will become.

• Conditioning can happen every hour.
• In the beginning, the stimulator usage can be 15-30 minutes each session or less.
• As the diaphragm gets stronger, the length of sessions should increase and the number of daily sessions should decrease.
• Allow 45-60 minutes between sessions to allow the diaphragm to fully recover.
• Always consult your physician before making any changes to daily pacing sessions.
• You will need to keep a log of your conditioning progress, from day to day, and bring log sheets to yours first doctor’s visit.

Use the diaphragm pacer conditioning log form to help you keep track of how you are doing.

Conditioning Warnings

Stop conditioning session and place patient back on the ventilator if:

• You notice any change in heart rate or have feelings of chest discomfort.
• You have shortness of breath or any discomfort that persists or worsens.
• Your oxygen level drops below 90 percent.
• Management of your secretions becomes difficult.
• Your borg scale is 4 or greater.

Borg scale of breathing effort

• 0 = No breathlessness at all
• 1 = Very slight breathlessness
• 2 = Slight breathlessness
• 3 = Moderate breathlessness
• 4 = Somewhat severe breathlessness
• 5 = Severe breathlessness
• 7 = Very severe breathlessness
• 10 = Maximum breathlessness

• Always wear a Passy-Muir valve while sleeping to help prevent obstructive sleep apnea. Use caution when eating and drinking while conditioning.
• A Passy-Muir valve (speaking valve) should be worn during these conditioning sessions to reduce the risk of aspiration (food going into the lungs and not your stomach).
• Use your abdominal binder when you are in your chair as this may improve your tidal breathing volumes.
• You should not have assisted cough techniques done on the abdominal area until one month after DPS is inserted. The month’s time is necessary to allow the inserted electros to heal in the diaphragm. Hands can be placed on your upper chest and vibrated to loosen secretions.
• The use of the in-exsufflator can be continued for airway clearance.

Warning: External electrical stimulation should not be done on the chest area during the conditioning sessions.

You must have a mechanical ventilator and resuscitator bag available at all times. You should be bagged with the resuscitator bag or placed back on your ventilator immediately and the pacing system turned off if:

• You feel that you are not receiving adequate breaths.
• You suspect that the pacing system is malfunctioning.