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<DT>
posted
End stage and pre-end stage COPD often delivers RTs the conundrum of the vent dependent patient. Most RTs feel that complete weaning for these patients is best or only goal and devise care plans accordingly. Is there a decision juncture employed to decide when that goal should change to accept full or partial mechanical dependency? COPD sufferers can degrade to not having enough viable lung to accomplish weaning. Many COPDers who might wean may actually be happier and healthier (even less costly, maybe?) if mechanical ventilator support was incorporated into their ADL. Opinions, experiences?
 
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<GJ,RRT>
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I would not consider a patient vent dependant till 4-6 months of failed weaning. All other issues must be resolved with only COPD keeping them on the vent. An important thing to address is appropriate nutrition, indirect calorimetery and prealbumins. The other is strengthening. I'm a believer in "Bag and Drag"(bag while ambulating). When the patient is in their best condition start the weaning. If a patient is near vent dependancy my goal would be vent at night and work towards TTAV/respironics cadance system during the day. If the patient is determined to be vent dependent, then I agree stop the weaning process. There is no sense weaning the unweanable, it just stresses the patient and takes time away from the weanable patients. Sounds like you work at an LTAC.

Good luck,

GJ
 
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<DT>
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I managed a sub-acute arena after many years of managing home based ventilator patients. I once had as many as 200 home vents of all ages, etiologies, etc... Once in the sub-acute I ran into a COPD wean or die mentality that I found quite disconcerting. If they could be weaned I weaned them (they were frequently just over sedated by the referring acute care facilities). If not I set them up with partial or full time life support. Often I found that those left with support were better off than those fully weaned. Though independent of the machinery they were back into the physical limitations and truncated emotions imposed by their WOB. We recognize the cost of breathing in end stage COPD and some do institute non-invasive support proactively for fatigue respite. Affording support in advance of a resp failure episode is clearly better than bringing them back after wards to the same point.
 
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