All Posts Tagged: Ventilator Weaning

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Ramon Segobia

Ramon Segobia came to ACHSNM for ventilator weaning after contracting COVID-19
Ramon spent a month on a ventilator due to COVID-19. To wean from the ventilator and begin his recovery, he came to ACHSNM.

Ramon Segobia is a 68-year-old gentleman from Las Cruces, NM. He has lived an active and independent lifestyle with Irma, his wife of 50 years. Ramon loves to garden and spend time outdoors, hiking and fishing with his grandchildren. He also enjoys officiating high school sports such as football, basketball, and baseball.

Believing he was having a severe allergy attack one October day, Ramon went to the hospital. Tests revealed that the symptoms he experienced weren’t due to allergies, but COVID-19. Irma also tested positive for COVID-19. They were sent home with medications to rest and recover. Ramon’s symptoms worsened and he had to return to the hospital where he was placed on a ventilator. After almost a month in the hospital, Ramon received a tracheostomy and PEG tube for nutrition, remaining on the ventilator. Irma, meanwhile, was able to remain home and recovered well there.

In mid-November, Ramon was admitted to Advanced Care Hospital of Southern New Mexico (ACHSNM) to wean off of the ventilator and recover from the effects of COVID. When he arrived at ACHSNM, Ramon was completely dependent and had only awakened for the first time in almost a month. Ramon recalls being unable to move his left arm and leg when he first woke. He thought to himself that he had to do something to get better, so his family wouldn’t have to bear the burden of taking care of him forever.

With what he described as some “tough love” and the support of the ACHSNM staff, Ramon successfully weaned off the ventilator in just two weeks. He was decannulated two weeks after that. Soon after he passed his swallow study and gradually increased his ability to participate in therapy. He expressed his thankfulness for his occupational therapist, Nate, his nurses, Angelica, Alex, and Margarita, and his respiratory therapist, Rachel, who all pushed him to participate in his care and get stronger. After 37 days at ACHSNM, Ramon had progressed enough that he was ready to move to the next level of care where he could get even healthier, gain endurance, and prepare to go home.

Ramon was then admitted to the Rehabilitation Hospital of Southern New Mexico (RHSNM) in late December. At RHSNM, he quickly progressed with therapy and was able to tolerate a regular diet again. He says that his physical therapist, Brian, and his occupational therapist, Art, supported and pushed him to get moving quickly and motivated him to get better and get home. Ramon was successfully discharged home after only 15 days at RHSNM. He returned home to his wife, who thankfully had fully recovered herself, and began outpatient therapy at RHSNM in late January.

To this day, Ramon continues to improve with his mobility and endurance and says that he looks forward to getting healthier, losing more weight, and getting back to fishing with his grandchildren again very soon!

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The Importance of Ventilator Weaning in Recovery

There’s no question that mechanical ventilation has saved countless lives. It provides life-sustaining oxygen for patients who can’t breathe on their own – but weaning them off of a ventilator is a challenging task that requires a variety of skills, technologies, and teamwork.

Hospitals today are developing more effective weaning protocols while ventilator manufacturers are creating improved technology that helps better reach the goal of restoring full breathing function in patients whenever it’s possible. Here’s a look at the many factors that emphasize the importance, and challenge, of ventilator weaning.

The Challenges of Ventilator Weaning

Sedation is a fact of life for most patients on long-term ventilation, but sedation can prolong dependence on the ventilator, as well as impact cognitive functioning. Some doctors suggest using non-sedating medications, which allow for earlier weaning. The impact of heavy sedation includes not only cognitive effects, but also can result in long-term neurologic issues, and even post-traumatic stress disorder.

One of the challenges with sedation, however, is that it can affect every patient differently. Research has shown that patients who are typically calm in normal life will most likely remain calm on a ventilator, while patients who struggle with issues such as drugs, alcohol or anxiety issues can have more problems while on ventilation.

Another factor that has been shown to help hasten weaning is mobility. Hospitals that stress early mobilization programs for patients on ventilators have seen good results. It’s healthy for both the mind and body; in fact, the muscles in the diaphragm weaken because they don’t have to do any of their normal work during ventilation. Moreover, all of the muscles can weaken because they’re used much less than they were prior to the patient’s illness, and combined with sedation can result in weakness after just four or five days on a ventilator.

Enhanced Technology

The scientific community has made great strides in the past decade in terms of developing technology that prevents or limits complications associated with mechanical ventilation. Additionally, both safety and workflow have been improved to help enhance the ICU environment.

Additional improvements, such as the addition of microprocessor control and electronic medical record systems, have helped advance technology, as well. In general, devices today are more sensitive to patient interaction while capturing important patient clinical data. And having ventilator data remotely available provides access to clinicians with the necessary tools to make important decisions – whether they’re at the patient’s bedside or not.

The Importance of Teamwork

The process of successfully weaning a patient off of a ventilator is best served by a team approach that includes respiratory therapists, nurses, physicians, physical therapists and other clinicians. It’s important that all parties involved stick with protocols that may have been established by the respiratory therapist. Protocols also need to be reviewed periodically and compared with hospitals of similar size.

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