Ventilator Weaning in the patient with TBI

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Ventilator Weaning in the patient with TBI

• Lakeview Specialty Hospital Rehab
• Waterford, WI
• Robyn Rushing, RRT Holly Sennet, SLP Robert
  Rushing, CRT

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Our Goal

• Patients who have suffered from moderate to
  severe TBI are often transferred from an ICU or
  acute hospital setting to a Long Term Acute Care
  or Rehabilitation Hospital for ventilator
  weaning, medical stabilization, rehabilitation
  and optimum discharge planning to a home
  environment.
• We would like to share with you some of our
  successes in this area and highlight the TEAM
  Multi-disciplinary approach that has been
  utilized in our facilities for the last 2 years
  that has had excellent sustained outcomes.

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Definition of Traumatic Brain Injury

• Traumatic brain injury is defined as damage to
  the brain resulting from external mechanical
  force, such as rapid acceleration or
  deceleration, impact, blast waves, or penetration
  by a projectile.
• Brain function is temporarily or permanently
  impaired and structural damage may or may not be
  detectable with current technology.

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Mechanical Ventilation Definitions

• Definition Mechanical ventilation is
  life-supporting ventilation that involves the use
  of a machine called a ventilator, or respirator.
  The goal of mechanical ventilation is to support
  breathing when a patient is no longer able to do
  so effectively on their own. Mechanical
  ventilation is generally the last resort when a
  patient is having difficulty breathing and cannot
  maintain adequate oxygenation.
• When a patient requires mechanical ventilation, a
  tube is inserted into the throat by a process
  called intubation. The (ET) tube extends down the
  trachea and into the lungs and is connected to
  outside plastic tubing that hooks up to the
  ventilator.
• In prolonged ventilation the ET tube may be
  replaced by a tracheostomy. A tracheostomy is a
  procedure that creates an opening through the
  neck into the airway through which a tube is
  placed. The tube, called a tracheostomy tube,
  allows air to flow into the lungs and allows the
  airways to be suctioned.

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Therapist Driven Protocols

• Patient Driven Protocol
• Assessment Protocol
• Ventilation Protocol
• Invasive
• Non-invasive
• Conservative ventilation parameters
• Minimizing pressure and lung injury
• Improving oxygenation

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Multi-Disciplinary Approach

• Therapies
• PT Vent mobilization protocol
• OT Resuming ADL function asap
• SLP Evaluation, Communication, Swallowing and
  Education

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Combining the Processes

• Weaning Protocol advanced
• Early ambulation advanced equipment and
  therapies
• Regaining H.O.P.E.
• Healing
• Objective
• Persistence
• Encouragement
• Positive Engagement
• Care Givers
• Family
• Patient

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Communication is Key

• Cognitive and Speech Therapy The core of the
  patient
• Giving the patient a voice
• Patience is instrumental in achieving positive
  feedback
• Speaking valve
• Passy-Muir
• Dynavox
• Portable augmentative and alternative
  communication device. This electronic speech
  generating device enables those who are unable to
  speak the ability to communicate using text,
  symbols and audio playback.
• iPad Applications for communication, swallow and
  education
• Phrase Board
• Verbally
• Speak IT
• Assisted Chat
• Dysphasia

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Supporting Roles

• Pharmacy
• Effective Sedation
• Role of the clinical pharmacist (PharmD)
• Stress, agitation and pain
• Nutrition
• CO2 Monitoring
• Carbohydrates
• Electrolytes
• Protein
• Psychology
• Patient
• Family
• Case Management/Discharge Planning

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Case Study Discussion

• Male patient
• Ventilator
• Trach
• Oxygen demands
• Vocal cord paralysis

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Success!

• Every case is unique
• The commonality is our humanity
• This work is a calling..not for everyonebut
  absolutely rewarding
• Thank you for doing what you do to change the
  lives of others. It is a worthwhile pursuitand
  worthy of recognition!

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QUESTIONS ?