My father-in-law was recently hospitalised for a case of necrotizing pneumonia that went septic. He is currently intubated and has been on a respirator for 18 days. Although his infection is improving he is still not out of the woods.
I have two questions for the forum. First, the doctor has suggested that they might soon ask permission to perform a tracheotomy on him when his vitals stabilize. I think he would like to avoid this procedure if he were making the decision. Is it realistic to think that he can remain intubated until he no longer needs the vent?
The second question is a corollary. How long does it usually take for someone to be weaned off of the vent when they have been on it for two or three weeks?
Question 1: Is it realistic to think that he can remain intubated until he no longer needs the vent? Difficult to just answer with a blanket yes or no. I have had a little luck with weaning a patient who has been on the vent as long as your father while still intubated with endotracheal tube, however it is less likely that weaning attempts will be successful. I understand your reticence to go for tracheostomy, but it is a better long term airway than the ET tube for several reasons. The ET tube fills the mouth making oral care difficult, and offers a greater chance for skin breakdown issues around the mouth with the ties or holder that have to be used. When it comes to weaning the trach tube is shorter overall and has less resistance to breathing and less rebreathed volume so weaning usually progresses better with the trach tube. I would go for the trach at the point the medical staff makes the recommendation in most cases. I usually like to see a good weaning effort with the ET tube before commitment is made to the trach, but each case is different and would defer to the docs judgment if that is the recommendation.
Question 2: How long does it usually take for someone to be weaned off of the vent when they have been on it for two or three weeks? There is no simple answer to this question either. This depends entirely on the clinical status of the patient. If the primary pulmonary disease process is well on the way to resolving, there is no significant compromise of other organ systems, nutrition is well managed, and there hasn't been too much general weakening from the overall course of the illness, things can progress rather quickly, as in several days from beginning to end of the weaning efforts. There are so many factors that have a potential effect that it will usually take longer, and if additional clinical issues present after weaning is initiated it can take much longer. I sincerely hope your father inlaw is free of the vent soon. Please let us know if we can assist further.
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