Jeff’s Next Breath:
Making It Happen
Without mechanical help, Jeff
cannot breathe. Sounds horrible, but it may have saved his life and
prevented brain damage. As he lay at the bottom of the pool before help
arrived, Jeff’s paralyzed lungs couldn’t gasp for air, so they didn’t suck
in water. Once resuscitation started, the relief was immediate.
Jeff uses several technologies
now to help him breathe:
 Breathing
Pacemaker: Jeff is one of a comparatively small -- but growing
-- number of high quads who use a phrenic nerve pacemaker to approximate
the normal process of breathing by means of externally-induced electrical
stimulation. More...
Ventilator
Machine: When Jeff is using a ventilator machine -- a
mechanical air pump -- a plastic hose from the machine pushes air through
a hole in his neck and into Jeff’s lungs. He is gently blown up like a
balloon about twelve times per minute.
More...
Suctioning
High quads lose the ability to
cough at the same time they lose the ability to breathe. This means that
fluid buildup in the lungs can become a serious problem. It is
uncomfortable, it degrades the efficiency of the lungs, and it tends to
incubate infection that can be fatal.
Jeff uses two methods to clear
his lungs:
 Suction
Pump: The most widely used method,
it involves pushing a sterile rubber tube down into Jeff’s lungs through
the opening in his neck. The tube is connected to a vacuum pump, which
sucks out the fluid. This device is considered “invasive” because the tube
intrudes into the body. It causes irritation that can actually produce
more secretions that have to be sucked out eventually.
 In-Exsufflator:
Less well-known, this machine uses both positive and negative
pressure to mimic the process of coughing. It is not “invasive,” because
no suction tube goes down the patient’s trachea. Using a switch, the
operator causes “positive pressure” to force a burst of air into Jeff’s
lungs -- as if he were taking a deep breath -- and then the operator
switches to the “negative pressure” cycle to suck the air out, along with
the fluid buildup. Lately we just keep the switch on positive for a long
time, and Jeff uses the airflow to manipulate the secretions and bring
them up into his mouth. Sounds yucky but it works.
We are strong advocates for
the In-Exsufflator, which should be more widely used as a supplement
to normal suctioning. The In-Ex machine is sometimes not used properly
during its evaluation by curious medical staffs, and they lose interest in
it. Demonstrators tend to use it on auto mode with low initial pressures,
with poor results. Medical folks would be convinced, however, if they saw
the machine operating in manual mode in the hands of an experienced user,
at reasonable pressure levels. The newest version of this “Cough Machine”
is made by the
J. H.
Emerson Company.
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