Transcript Ventilator Weaning in the patient with TBI

Ventilator Weaning in the
patient with TBI
Lakeview Specialty Hospital & Rehab
Waterford, WI
Robyn Rushing, RRT; Holly Sennet, SLP; Robert Rushing, CRT
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.
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.
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.
Therapist Driven Protocols
• Patient Driven Protocol
• Assessment Protocol
• Ventilation Protocol
– Invasive
– Non-invasive
• Conservative ventilation parameters
– Minimizing pressure and lung injury
– Improving oxygenation
Multi-Disciplinary Approach
• Therapies
– PT – Vent mobilization protocol
– OT – Resuming ADL function asap
– SLP – Evaluation, Communication, Swallowing and
Education
Combining the Processes
• Weaning Protocol – advanced
• Early ambulation – advanced equipment and therapies
• Regaining H.O.P.E.
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Healing
Objective
Persistence
Encouragement
• Positive Engagement
– Care Givers
– Family
– Patient
Communication is Key
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Cognitive and Speech Therapy – The core of the patient
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Giving the patient a voice
– Patience is instrumental in achieving positive feedback
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Speaking valve
– Passy-Muir
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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.
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iPad Applications for communication, swallow and education
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Phrase Board
Verbally
Speak IT
Assisted Chat
Dysphasia
Supporting Roles
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Pharmacy
– Effective Sedation
– Role of the clinical pharmacist (PharmD)
– Stress, agitation and pain
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Nutrition
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CO2 Monitoring
Carbohydrates
Electrolytes
Protein
Psychology
– Patient
– Family
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Case Management/Discharge Planning
Case Study Discussion
• Male patient
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Ventilator
Trach
Oxygen demands
Vocal cord paralysis
Success!
• Every case is unique
• The commonality is our humanity
• This work is a calling…..not for everyone…but
absolutely rewarding
• Thank you for doing what you do to change the lives of
others. It is a worthwhile pursuit…and worthy of
recognition!
QUESTIONS ?