My mother has just failed her third attempt at vent weaning. She is 72 and has advanced COPD (with cor pulmonale). BTW this was the 1st time her COPD was diagnosed. The course has been uneventful until now, and then she ended up in ICU with acute respiratory failure. I am a psychiatrist so not much of an expert in these matters. I have been reading a lot on end-stage COPD these days, but reading is not enough. I wonder if you could help me. The ICU doc asked me this Sunday whether I wished my mother to be put back on MV. He said the prognosis is poor anyway, so she is likely to die on MV, which he said is not something he would recommend. This in his opinion would only add to her suffering. My question is, is there a possibility that she might succeed another weaning trial, and second – is there really no means of relieving the pain and distress while on MV? NB. We are in a hospital in Poland and protocols in use here may differ from those in the US. So far my mother has received no palliative treatment whatever for her symptoms despite my suggestions.
She has not been trached.
I wonder if I should perhaps try and transfer her to another facility with more experience in difficult weaning (this one is a university clinic but I'm not sure about their expertise in this particular area). Do you think the risk is worth taking?
To give you any kind of accurate assessment of risk/benefit for your mother with the info you provide is tough. Based on what you offer here, I would say first long term weans are usually done best at facilities specializing in just that. The difficult to wean advanced COPD patient, in my experience, if unable to succeed at an acute care facility, will have the best chance of success at a weaning center. Next it is usually best for any patient having weaning challenges to undergo a tracheostomy. To answer your question about pain and distress is: generally yes there are medications which can attenuate this without ablating the respiratory drive needed to succeed at weaning. I hope things are improving and all goes well for your mother.
Thanks so much for your reply. I do realize it must be difficult to go into detail with so little info. Unfortunately the facility in question has no experience in difficult weans. And there are no specialized weaning centers in Poland.
Things are going from bad to worse. But I have one more question: what are the medications that can be used to relieve pain and distress without compromising the respiratory drive too much? My mother is actually on morphine.
Careful titration of the morphine and anxiolytics and perhaps anti-depressants. It is a tough balancing act, but when done well in balance with the human touch can really help settle a patient and help them to be more comfortable. Too much pain control and sedation obviously carries the potential to prolong the weaning process.
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