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Chances of Success for Weaning

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October 07, 2007, 08:01 PM
Heather
Chances of Success for Weaning
Gary,

My mother has been on a vent for 45 days. She arrived at the ER from the nursing home for "shortness of breath and wheezing." She didn't present those symptoms but was found to be dehydrated, had a UTI, and glucose levels at nearly 400. After not responding to several insulin doses, she finally did and her stats plummeted - glucose level went down to 14 and that's when she was put on the vent and sent to the ICU. She was given several antibiotics over the period of a few weeks (positive blood cultures, etc.) and, once most issues became relatively stable, she was transferred out of ICU to an acute care facility to focus on vent weaning. She has been there a little over 2 weeks and I haven't seen much progress.

My mother has a central line, trach, and PEG tube put in place and when she is awake, she is quite agitated and is sometimes given Ativan. Understandably, she needs to come off of sedation so she can respond to weaning.

The pulmonologist remains positive but my concerns are not alleviated. She has a head injury that caused cortical blindness, impact to short-term memory, is on a cocktail of meds, and has been in a nursing home for over 20 years (but is only 62 years old). Her agitation is very upsetting and I don't know what level of pain she is in because she is not responsive to me.

I guess I don't really know what my question is... what are the chances she could successfully wean? There are no long-term vent facilities, as I am aware, in Tennessee and moving her to a state that has one is just not an option.

Any insight you can share would be much appreciated.

Sincerely,
Heather
October 08, 2007, 10:46 AM
GaryMefford
Heather,
your mother obviously has faced and continues to face many clinical challenges. With complex cases many things have to be brought into balance for a patient to do well. Weaning initiation and ultimate success does not always require perfect balance to be established in all areas. When her physiology is ready to resume her work of breathing she will have a postive response to a spontaneous breathing trial. Although significant, none of the challenges you have described completely preclude her from potentially weaning. It is impossible to quantify her chances for success, and her responses to the weaning trials will give a more clear picture of her potential. Ativan in my experience if dosed carefully doesn't have to eliminate the respiratory drive. I have often found it a helpful medication for anxious patients when anxiety was the reason they had difficulty weaning. Fluxuating blood sugars are frequently part of the picture for some patients and once controlled is not a wean buster. The fact that your pulmonogist is positive is good. You might seek information as to the weaning plan, and what medical criteria she is to meet before she is able to be advanced into full spontaneous breathing trials. She may be closer than you think. I hope things progress well and quickly for you and your mother. I also hope this is helpful for you.