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Vent weaning question at this point

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May 08, 2006, 01:40 PM
<michelle>
Vent weaning question at this point
Gary,
My mother has been in a LTACH on a vent protocol for 30 days. She has done up to 20 hours, got ventilator pneumonia, recovered andnow has done up to 12 hours. She has COPD and is 85 but has no other underlying ailments. It seems like she can do 7, 10, 12 hours but I don't know if she can be fully weaned. The Physical Therapist who works with her daily has rated her fair (scale is poor, fair, good and normal). She can sit in a chair for 45 minutes to 1 hour and has good upper body but weak lower body. Prior to LTACH she was in acute care hospital for 6 weeks. Is it reasonable to assume she could be weaned in 30 days or should we consider setting a time of say 60-90 days? We would prefer not to put her in a subacute where there will be no weaning and just wait for her to deteriorate. She has all her faculties and was prior to the initial resp failure, caused by pneumonia, ambulatory and independent. We would prefer a home based solution but the hospital discouraged that up front when we moved her there (too hard for the family, too expensive etc.). What do you think and any advice would be appreciated. I live in Southern Cal and there are not many facilities to choose from.They talked about nocturnal vent but given she has days where she can only tolerate an hour I'm not sure what good that would do (and I'm not sure what it means either). Thanks. Michelle
May 15, 2006, 06:18 AM
GaryMefford
Michelle,
You have excellent questions. It is difficult to state just how likely weaning is for your mother. If she is still making small incremental progress and her team of care givers are still advising to continue with the weans then I would say, yes it is reasonable. As to what time frame you should look for this to be achieved by, this is difficult to say. Your assertion about a subacute or long term care offering little hope of additional weaning activity has been my observation in my part of the country as well. Something I hope one day to do something about. Noctornal ventilation is often a good option for patients such as your mother, however if the periods off the ventilator are not maintained then they can well wind up on continous ventilation. Noctornal ventilation is still ventilation and if provided in the home still has pretty much all of the same challenges as contionous ventilation. If they feel she can be discharged on noctornal ventilation and are offering that as an alternative goal, it might be worth considering. In a situation like this advice is difficult. You are doing what you can to educate yourself, based on the level of your statements. That is great. Continue to face each day with hope. You must take in all that the team is telling you and follow where your heart leads you. Some people not familiar with LTACHs might look at this and say "30 days is too long", but I have seen successful weans well beyond that point. Sometimes all of the excercise, SBTs, nutrition, and medications seem to bring the patient to a new level of strength and what they were not able to do, they just can. I have seen the opposite as well, and the longer it goes on the greater the chance of your mother's physiology just not being able to hold up to weaning efforts. As long as weaning is your goal, make sure the team is kept aware of that, and continue to hope and provide a hopeful face for your mother. My heart goes out to you. If we can help further, please let us know.
Gary