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“Does a diaphragm pacer work for long-term ventilated adults and children with tracheostomies?” That’s a question we get frequently.

My name is Patrik Hutzel from intensivecareathome.com, and let’s do a deep dive into that question today in this tip. 

So, one of the questions that we’re getting frequently is, “Is the diaphragm pacer working for long-term ventilated adults and children with tracheostomy?” and the answer is like with many questions, that it depends. 

A diaphragm pacer can work for long-term ventilated adults and children with a tracheostomy depending on their conditions. Diaphragm pacing is a medical technology designed to stimulate the diaphragm; the primary muscle involved in breathing. It can be particularly helpful for individuals with conditions such as high cervical spinal cord injuries, patients with intact phrenic nerves, but impaired voluntary control of the diaphragm, and also, it can help work in certain neuromuscular disorders if the diaphragm retains some functional capacity.

So, for example, one of our clients with a C1 spinal injury does have a diaphragm pacer, and it works very well for him because he can be liberated from the ventilator during periods of time during the day, but also overnight, potentially. It is helping the client to be less dependent on ventilation. But also for this particular client, he can talk with the speaking valve, so it just improves the quality of life.

What are the benefits of a diaphragm pacer? Like I said, reduction in ventilation dependence. By stimulating the diaphragm, it allows patients to breathe more independently, potentially reducing the use of a mechanical ventilator. That goes without saying that it improves the quality of life. It can enhance mobility and communication by reducing reliance on a ventilator. It decreases the risk of ventilator associated complications to reduce mechanical ventilation, simply lowering the risk of infections and complications like pneumonia.

For which patients is it suitable? So, the diaphragm pacer is definitely not suitable for all patients. It requires intact phrenic nerves to transmit the stimulation signals. It needs a functioning diaphragm muscle. Patients with severe diaphragm atrophy, significant neuromuscular disease, or phrenic nerve damage may not be eligible or suitable.

What’s the assessment and procedure? A thorough evaluation including nerve conduction studies and diaphragm function tests are necessary to determine eligibility. If deemed suitable, the pacer is surgically implanted, and the patient undergoes a period of training to adjust to the system.

What are the challenges? While not all long-term ventilated adults and children will benefit, the procedure carries surgical risk. Regular follow-ups and maintenance of the device are required.

In summary, diaphragm pacing can be an effective alternative for certain long-term ventilated adults and children with tracheostomy, but it requires careful evaluation to ensure the suitability.

Also from experience, I can tell you, having looked after long-term ventilated adults and children in the community that have a diaphragm pacer, applying the pacer to the patient’s skin, and you need to do that daily, you need to apply it and then remove it, it’s a bit of a skill because it needs to be exactly where the electrodes are placed for the pacer. So, that’s also a little bit of a skill and you don’t put it right in the right spot sort of, if it’s only off by a couple of centimeters, it may not work properly. So, there’s definitely more than meets the eye, and certain things have to happen on a day-by-day basis once a diaphragm pacer is in place. But for the patients that it works, it’s fantastic. It’s one of the best things that can happen for a long-term ventilated patient with tracheostomy, whether adult or child.

So, how does this tie all in with Intensive Care at Home? Well, with Intensive Care at Home, we are currently providing 24-hour critical care nursing at home. Therefore, we are providing a genuine alternative to a long-term stay in intensive care for ventilation, tracheostomy, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), ventilation without tracheostomy, and tracheostomy without ventilation, also Home TPN (Total Parenteral Nutrition) (181), home IV potassium, and home IV magnesium infusions. We’re also providing ventilation weaning at home. We’re also providing port-a-cath management, central line management, PICC (Peripherally Inserted Central Catheter) line management, and Hickman’s line management at home. We’re also providing nasogastric tube management and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home. We’re also providing palliative care at home. Many of our clients do have spinal injuries, such as C1, C2, and they’re ventilator dependent. That’s where the diaphragm pacer really can make all the difference.

We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of the Western Sydney Local Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home instead of going to the emergency department. 

We’re also, therefore, in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs around $5,000 to $6,000 per bed day. Our service costs between $2,500 to $3,000 per bed day, and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. Most importantly, we’re improving the quality of life for patients and their families. So, it’s a win-win situation for all stakeholders.

With Intensive Care at Home, we’re currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We’re a NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme) in Queensland, as well as the Department of Veteran Affairs (DVA) all around Australia. Our clients, and we as a provider have also received funding for public hospitals, private health funds, as well as departments of health.

We are the only service provider in Australia that has achieved third-party accreditation for Intensive Care at Home nursing in 2024. We have been achieving this level of accreditation since 2012. No other provider has achieved this high level of accreditation in the community and has created more intellectual property for Intensive Care at Home nursing than we have. This puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2024 employs a higher skill level in the community than we do, which enables us to look after the highest acuity adults and children in the community in Australia safely.

If you’re at home already and you’re watching this and you realize that you don’t have the right level of support, I can show you today how we can help you. One of our first clients, or about 10 years ago was a client who was at home on a ventilator with a tracheostomy with support workers 24/7. Of course, support workers cannot keep a patient at home on a ventilator with a tracheostomy. That is an intensive care nursing skill. It’s like, having support workers instead of intensive care nurses is like flying the airplane with the cabin crew instead of the pilot, because anyone on a ventilator with a tracheostomy is at very high risk of dying or sustaining medical emergencies. He was going in and out of ICU because support workers simply could not keep him out of hospital and out of ICU because they don’t have the skills, the experience, the knowledge, or professionalism to look after ventilator and tracheostomy client at home. It’s an intensive care nursing skill and a critical care nursing skill only. It’s not even the skill of a general registered nurse.

Eventually, this client found out about us. We were proving our concept with this client very fast. When we worked with the client, we sent him intensive care nurses, 24 hours a day. He never ever went back into ICU ever again, and we were proving our concept there very, very fast. We can do the same for you.

If you’re not safe at home which includes, you don’t have the right level of funding and right level of skilled staff, we can help you with that. It includes the advocacy that goes along with getting the relevant funding. We have always successfully advocated for our clients, otherwise, we would not be in business.

This is also why we’re providing Level 2 and Level 3 NDIS Support Coordination. We have a team of NDIS support coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, our NDIS support coordinator. I will put a link to an interview with Amanda in the written version of this blog below the video. We are also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

If you’re a NDIS support coordinator or a case manager from another organization watching this and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for nursing care for your participants and you don’t know how to go about it and what evidence to provide, I encourage you to reach out to us as well. We can help you with the right level of funding and with the right level of advocacy. We are also providing NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.

If you are a critical care nurse and you’re looking for a career change, we’re currently hiring for critical care nurses in the home in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, and in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed a postgraduate critical can in qualification, we will be delighted hearing from you.

I have a disclaimer though, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients do want the same staff coming over and over again, because they are very vulnerable and very special, and that’s why we need regular staff. So, if you are looking for agency work, where you can come and go, this won’t be the right fit for you. We are looking for consistency and our clients are looking for consistency. So please, only apply with us if you can give us regular and consistent availabilities for shifts and you’re really keen on building relationships with us and with our clients. 

If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We are currently expanding our medical team as well.

We can also help you eliminate your bed blocks in ICU and ED for your long-term patients or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help you take the pressure off your ICU and ED beds. In most cases, you won’t even pay for it. Even if you do pay for it, it’s much more cost-effective than what you’re paying in ICU and ED for.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, respiratory wards, etc., please reach out to us as well. We can help you there fast.

If you’re in the U.S. or in the U.K. and you’re watching this and you need help, we want to hear from you as well. We can help you there privately and with consulting and advocacy.

Once again, our website is intensivecareathome.com. Call us at one of the numbers on the top of our website or simply send us an email to [email protected].

If you like my videos, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and intensive care. Click the like button, click the notification bell, and comment below what you want to see next, what questions and insights you have from this video.

Thank you so much for watching.

This is Patrik Hutzel from intensivecareathome.com, and I will talk to you in a few days.

Take care for now.