Its been about 3-1/2 weeks since the accident.
He was intubated for 13 days and then trached.
Two days ago he was movedfrom CCU to ICU and they have determined that he will take "more than 10 days" to wean of the vent and has to be moved to an intermediate facility to be weaned.
They won't say if they think weaning will be successful or not. He can't go to a rehab facility unless he's weaned off the trach.
He is considered a 'quad' but can move his arms just not his wrists or hands and no movement below the diaphragm. Will he breathe on his own again? Will weaning be successful? How long will it take to wean him, before he qualifies for rehab? I'ver heard fronm 2 wks to 3 mos- but the averagew long stay for weaning is about 4-5 wks. We (his family) are confused, and obviously quite upset. We don't know where to go to ask and get straight answers.
I CURRENTLY WORK AT A FACILITY THAT WEANS PATIENTS FROM THE VENT. YES, ARE AVERAGE IS ABOUT 1 TO 2 MONTHS TO WEAN. I AM ASSUMING THAT YOU SON WAS YOUNG AND HEALTHY BEFORE THE ACCIDENT? I UNDERSTAND THAT ALL OF THIS CAN BE VERY FRUSTRATING, BUT PLEASE BE PATIENT. ARE THEY GIVEN HIM ANYTHING THAT WOULD SUPRESS HIS BREATHING? MORPHINE, DIPROVAN ECT.? IS HE INITATING ANY BREATHS ON HIS OWN?
A C5 quad typically has fair to good function of most of their muscles of respiration. He has a good chance of weaning. There are many challenges that any vent patient comes against such as infection, nutritional challenges, skin issues, and psychological among many others. Time will vary depending on the challenges that he faces. I know it is hard sometimes to get straight answers, but you need to be able to expect exactly that from your primary doc and any consultants on the case. The care team should be able to give you a family meeting and lay the cards on the table for you. Speaking for the group, our heart goes out to your son, you and your family. This is very tough. Be patient, stay close, informed and advocate for your son. If you have any more questions we can assist with please bring them to us.
Good luck, and God bless.
I'm so sorry I haven't gotten back to your kind responses sooner, but there are so many things happening right now that I'm just starting to straighten things out and had forgotten that I'd found this site and posted here.
Yes, he is young (33) and strong before the accident. He is currently (since the beginning of Oct) in a rehab hospital in Balto- Kernan's.
It was a 'rush'job. One minute we were tying to figure out where he could go, because the rehab hospital couldn't/wouldn't take him-then 2 hours later he was transferred to the rehab hospital's ICU. We were very pro-active and were making 'waves' there, & I think they wanted to get rid of us 'troublemakers' ASAP.
He has had asthma all his life and is having a difficult time with the trasche and frequently needs 'suctioning'. His older (by 3 yrs) sister is caring for him every minute and is learning how to suction and cath him. she wants him to come to her house after the hospital.
They've just yesterday, given him a smaller vent to wean him down to removal soon. He's noe on thin liquids and solid food, but must be very careful not to aspirate.
I just yesterday learned that a family meeting will be called soon (I don't know when). He is having some skin issues(pressure sores) on his heel(s) and at his coccyx area. They don't seem to be getting worse, but aren't improving (he's had the coccyx since he transferred here from Shock Trauma - the heel issue came later, after transfer) . These concern me and we've been on top of the staff about turniong every 2 hrs and are insisting that alternate methods be used to try to heal the wounds. His sister is a nursing student, his mother (my ex) is a nurse in a nursing home and my wife is a RN manager of long term care vent unit in a hospital. We are vigilant, and are surprised and frustrated/angered that the staff at the hospital isn't as vigilant as we'd like. He is moving in an electric chair, but has no wrist or hand movement,yet- but we're hopeful that the therapy sessions will help that.
Whew! Didn't mean to go on this long but the words seem to just keep riolling out.
We're trying to 'roll with the punches' but its seldom a calm moment with urgent things cropping up at every turn.
|<Dave Tolle RRT, RCP (ret)>|
BOB.. There are wound care specialists (R.N.'s and M.D.s) who can help with the decubitis ulcers. Yes, he needs to be frequently turned. P.T. can assist in locating and relieving pressure points in his wheel chair and elsewhere.
His trach tube should be the correct one for his anatomy and usage. Speech therapy or Respiratory can do simple aspiration tests to assess this situation. Watch the cuff inflation pressures if a cuffed tube is used. Too high a pressure will cause pressure sores inside the trachea which is not good. There are a number of tube products of various designs and purposes. He may need to change tubes as he learns better how to work with them.
Suctioning is a double edged sword. The process of suctioning irritates the mucousal lining so it actually results in more mucous production. So suctioning should be done only when needed and ideally with soft rubber cathters. Rusch makes a soft red-rubber suction catheter that is excellent for these cases. Too little suctioning leaves mucous in where it may plug airways or become infected. Learn some postural draining and percussion techniques (from respiratory care) to help your son in to help drain the mucous towards the trach so that it can be easily suctioned out. Keeping your son well hydrated will also help keep secretions more liquid and easier to remove. If your son can cough he can learn to expel mucous on his own. There is a rather esoteric tool from Emerson in Mass. called a Cofflator that is a non-invasive cough augmentation device. In summary too aggressive suctioning will result in chronic copius amounts of mucous. Just the right amount of suctioning will keep the airways clear and the lungs free from infection. Frequent turning will also help with mucous clearance and help prevent infection. It's a lot to learn but important for the long term quality of life for a vent dependent person.
Again, its been a few days since I've gotten back here to post, but I've appreciated your suggestions, greatly.
The percussive measures and suctioning have helped him a lot.
The trache was removed a coupla days ago, and now he's learning to try to cough and bring the mucous up on his own. Coughing is an effort, tho. They've brought a 'cough' (air pressure in/out) machine, but he says he's tring not to have to use it.
How long does the trache 'wound'/incision hole take to heal/close? He has steri-strips and bandage over it, but we can hear the air escaping thru it constantly.
It sounds as if he's gasping, but he says he's not. He still has the collar on from the C-5 surgery. Does that help heal the trache hole? (stationary position-kinda) He still can move his neck quite a lot, and wants to know when he can get rid of it. I think another month or so is what to expect for that, but don't know why the docs always answer questions with- "Its different for every one. Each patient is unique" (or some such drivel).
Gimme a break and make a wild guestimate for cripes sake! Hunh? Is that too much to ask?
At least you, here -who have experience with it are likely to have an 'approximate' answer.
Thanks for all the advice you've given.
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