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: 5/25/2008 Subject: weaning from a vent
Question QUESTION: My dad in on a ventilator because of pneumonia. He is 84. They are trying to wean him off today. The doctor has said that they might do a tracheotomy. Some family members are against this because they feel that he would not want to live with a tracheotomy. At the same time they say he "wants to live." It is my understanding that if he does not completely tolerate weaning from the vent that a trach will help the weaning process. He could go to rehab with a trach. Is going from a vent to a trach a normal course of treatment? Is a trach considered permanant? Thanks you.
ANSWER: Hi Ruth,
The normal course of events, technically, would be to simply wean from the vent. If the time on the vent becomes prolonged, usually greater than 10-14 days, the physicians look toward doing a trach. The endotracheal tube can damage the trachea and vocal cords, and prevents the patient from swallowing normally. Additionally, it is more difficult for the patient to breath through the smaller, slightly longer tube than it would be for him normally.
The trach is easier to breath through because it is so much shorter. It also allows the patient to be easily placed back on the vent if weaning doesn't go well. The patient is able to be awake, and may be able to eat and drink depending on their swallow ability. Some patients that can not be entirely weaned from the vent may go on the vent during the night and stay off during the day. These are nice advantages to the trach, and you're right, the trach does not have to be permanent.
There is another factor to be considered however. There is a rule of thumb that for every day a patient spends in the ICU on the ventilator, he or she will need 3 to 5 days of rehabilitation. It just gives you sort of a ballpark figure of what you may be up against.
Take care, I hope your Dad is better soon. Hillarie
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QUESTION: Thank you so much. My dad was switched to a trach yesterday. He is awake and responding to commands. He is not able to move very much. Is this normal after being sedated for 10-12 days? Should he be able to walk, etc. again? How long or how much rehab will he have to have to regain his ability to walk and use his arms? It this what the 3-5 day per 1 day in ICU refers to?
Thank you. You have been very informative.
Answer Hi Ruth,
I'm glad to hear he's doing better. Yes this is the rule of thumb I was referring to. The weakness you are describing is known as critical illness polyneuropathy or critical illness myopathy. It causes profound weakness of all the muscles. This may prolong the weaning as well as the rehabilitation. Approximately two thirds of patients diagnosed with this have almost complete recovery. Severe disability with some paralysis was reported in approximately twenty percent. It is common for the patient to have some form of milder disabilities such as foot drop, continued mild muscle fatigue, or neuropathies. Hopefully, he will start to gain his strength back now that he is awake. Make sure physical and occupational therapy are seeing him. Additionally, any moving he can do on his own will help. If he's able and willing, just working to squeeze and make a fist, or doing flex & point with his feet, lifting his arms or legs, anything to get him moving, will help.
Take care, Hillarie
