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.
Question Hi Hillarie, first of all thank you for all the information you provided from my last question. I will update you on what is going on now with hopes you can provide some additional insight into my mom's difficulty weaning. She has diabetes and goes to dialysis 3 times per week. As I had mentioned before she shows some signs of CHF. Each day she is loaded with antibiotics, nutrition via feeding tube, flushes after meds are given etc. It was determined that she needs to go to dialysis more frequently due to the excess of fluid intake. While that has helped remove a great deal of fluid from her she continues to be unable to wean. She does suffer from anxiety which is impacting her ability to wean. She is given anxiety meds 45 mins prior to weaning to help calm her but that doesn't seem to be working. Her O2 level drops dramatically within 5 mins to the point of almost passing out. I think she holds her breath involuntarily and they have difficulty getting O2 back into her airways when this happens until she relaxes at the passout point. I also am curious as to how long the body can tolerate this activity and what the concerns would be for someone who has been on the vent for a long time. She had a trach about 4 weeks ago after having been on vent via throat for a couple of weeks.
Sorry so long but any insight you can offer would be helpful.
Kim
Answer Hi Kim,
I think you're on the right track. It does sound like her anxiety is her limiting issue at this time. I don't think she's actually holding her breath. Instead I think she's demonstrating something that many people with lung disease run into.
First of all, when we get really anxious about something we sort of get tunnel vision. It's as if we can only concentrate on that one thing to the exclusion of all else. So if she's feeling she can't breath that's the only thing she can think of, despite everyone telling her to relax and breath nice & slowly.
Secondly, when we get really anxious we tense up. It's that fight or flight reaction. I'm sure it worked well when we were running from Sabor tooth tigers. Unfortunately, it uses up a lot of extra oxygen, which is a problem when you don't have enough oxygen in your system.
Thirdly, when people feel they are having difficulty breathing they tend to sort of pant. They use short, fast, shallow breaths trying to "catch up". Once again it works in the short term, if you just ran from a Sabor tooth and now are safe to rest. For someone like your mom, there is no catching up. Instead these small, quick breaths move air mainly back and forth through her airway, but only a little new air actually reaches her lungs where the gas exchange takes place. (If she could manage slow deep breaths it would actually help more, since more new air would reach her lung fields.)
When you put all these together you begin to understand her dilemma. She feels as if she can't breath, so her musles tense and she breaths as fast and heavily as she can, using lots more of the oxygen thats not available. This makes her feel panicky, so she breathes faster & all her muscles tense, working harder as well, so it becomes a vicious cycle, until she blacks out or someone puts her back on the ventilator.
It maybe that they decide to go more slowly with the weaning, either providing her more suport or increasing her medications to prevent her panic reactions.
She is demonstrating one of the concerns about ventilators, becoming ventilator dependent and having difficulty weaning. In combination with this, is a general deconditioning that occurs as well. The ventilator impedes her ability to work with physical therapy, so her muscles become weak from lack of use. Another concern would be her increased risk of infection both because she is in the facility and because she is on the ventilator.
I wish I could tell you it will all resolve quickly, but the truth is she's really in a tight spot right now. I think having difficulty breathing must be one of the most frightening health problems, to constantly feel you are struggling to get enough air. Be as loving and understanding as you can be. If you aren't already, some families bring in books on tape or music to help your mom pass the time, and distract her from her difficulties.
Make sure you take care of yourself as well. Sincerely, Hillarie
