AboutHillarie Speziale Expertise I can answer general questions about ICU care, the frequently used medications, procedures, and life supports. I can also explain many of the diagnoses and supportive measures used for patients with that particular illness. I am familiar with the infectious, cardiac, pulmonary, renal, and gastric problems that can land you in the ICU. I can not tell you exactly how long the patient stay will be, diagnosis your symptoms, or tell you with any certainty that the care you (or your loved one) received was wrong. I can also answer career questions regarding RRT and RN fields. Please note: neurology is not a field I have a great deal of familiarity with..
Experience I have 17 yrs experience as a Respiratory Therapist, and 9 yrs as a critical care nurse. I am familiar with infectious, cardiac, respiratory, renal and gastric diagnoses that can land you in the ICU.
Education/Credentials Assoc. Degree in Respiratory Therapy, Bachelor of Science in Nursing, Master of science in psychiatric nurse practitioning.
Expert: Hillarie Speziale Date: 5/24/2008 Subject: ARDS and respiratory care
Question My mother developed ARDS 35 days ago following emergency double bypass surgery. She is still on a ventilator through a trach. She is still sedated. She can breathe on her own for several hours now but she is unable to breathe appropriately when they try to reduce her sedation and wake her up. I understand why they cannot take her completely off the vent while she is sleeping. I understand the recovery can be lengthy. My question is this; is a person in her situation more likely to end up with lifetime dependency on the ventilator? Are the chances still as good for her as they would be if she were able to come off the vent within a couple of weeks? She was a slight smoker, non-drinker, overweight but not extremely obese, and 57 years old.
Answer Hi Eric,
I am a little confused. You mention that she can breath on her own, but remains sedated. Is she actually breathing on her own with only supplemental oxygen via a trach mask, or is she still receiving support from the ventilator when she's breathing on her own? The agitation you describe when she comes off sedation is frequently seen. While I'm probably not telling you things the healthcare team presently caring for her doesn't know, it is important to avoid abrupt discontinuation of long-term sedation infusions. Studies show this may result in extreme anxiety, agitation, and difficulty ventilating the patient. Lately the suggestion is to maintain a propofol infusion (it's a milk white looking fluid) for light sedation during weaning & withdrawal of the ventilator.
But that's not really what you were asking. Yes, it's still entirely possible for her to make a good recovery from this. There are some dangers still. ARDS can lead to a pulmonary fibrosis, which can make weaning more difficult. She may also have critical illness myopathy. This is often seen in severe illness, and is a global muscle weakness. It can involve the respiratory muscles as well as the limbs, and may account for her difficulty in weaning. Approximately two thirds of patients who develop this recover completely, another 20% have chronic weakness and partial paralysis. The remaining group have some milder form of neurologic problems.
Her age, mild smoking history, and abstinence from alcohol are all assets that will work in her favor. I would say, when appropriate, talk to her. Tell her what's happening in your life, in the lives of people she usually stays in touch with.
Take care, Hillarie
