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Weaning from the Vent
and Extubation
“Weaning from the vent”
means reducing a patient’s usage of the vent to the point the
patient is able to breathe again normally on their own, unassisted.
“Extubation”
means disconnection and removal of the mechanical vent tube from the
patient’s mouth and throat or tracheostome.
The ARDS Support Center
received an inquiry about the process of weaning the patient from the
Ventilator. The following comments were provided by Max Eskelson who
is a member of the ASC Board of Medical and Professional Advisors.
First, allow me to introduce myself -
my name is Max Eskelson, and I am a Respiratory Therapist at the LDS
Hospital in
Salt Lake City, Utah.
How long does it
take to wean a patient from the Ventilator?
The answer is,"It Depends."
There are so many variables that come into play that it cannot be said
with any certainty how long the course
might be. Some of the variables include the initial disease process,
the previous health of the patient, and
the
physical state of the patient When someone makes a prediction, they
are only quoting statistics. They are talking about the average.
Because they are talking about the average, it stands to reason that
some will recover more quickly, and some will take longer.
Over the years, it has become obvious
that physical therapy is paramount to lung recovery. The therapy may
include dangling on the side of the bed, standing, walking short
distances (and increasing the distance over time) a bed bike, and so
on. Another key ingredient is nutrition. The patient cannot exercise
and regain muscle strength without adequate nutrition. As to coughing,
the patient has a tube going down his throat, and this is not
comfortable (at best). It is irritating, and the mouth cannot be
closed. This feels strange. Secretions often do not play a role with
coughing. We see patients all the time with terrible coughs, yet have
no secretion production.
Sedation during the process may not be
a good idea. This is because it is desireable that the patient
actively participate in the various therapies that will allow
extubation (tube removal). There is a fine line that is walked between
not allowing the patient to experience pain, and allowing them to
participate in their care.
The basics for weaning from the
ventilator, and eventual extubation (they are two separate and
distinct actions) are:
1) taking care of the underlying
process;
2) physical therapy
3) nutrition, and
4) trials of spontaneous breathing.
Max Eskelson RRT, BSBA
The following was
contributed by Mark Lowery, formerly associated with the ARDS Support
Center.
Concerning weaning from
the vent, the process involves a gradual lessening of the reliance
upon the vent (oxygen level and pressure), with short and then
increasing periods of stopping usage of the vent to force and allow
the lungs to breathe on their own, ultimately to a point where the
vent is simply removed (extubation). If a trachesotomy has been
performed, this may also be a factor in the processes. The weaning
process has been the subject of medical research and articles, all of
which fairly indicate that each case is unique. A comparison between
how individuals handle the process is difficult to make.
.In some cases the
patient may seem to become mentally reliant upon the vent and fearful
that if it is removed they will no longer be able to breath.
Anti-anxiety drugs may be used to counter this fear. It may take
several attempts to wean, and this is neither unheard of or
necessarily abnormal. It may help to explain the weaning process to
the patient. Reassurance and calming influences such as reading,
prayer, soothing music or gentle massages may help the patient become
more at ease during the weaning process. Such efforts should be done
only with the permission and supervision of the medical staff.
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