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Today’s article is about, “Quick Tip for Families in
Intensive Care: Can My Dad Wean Off the Ventilator After TAVR with a Neurological Disease or Need a Tracheostomy?”
You may also watch the video here on our website https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-can-my-dad-wean-off-the-ventilator-after-tavr-with-a-neurological-disease-or-need-a-tracheostomy/ or you can continue reading the article below.
Quick Tip for Families in Intensive Care: Can My Dad Wean Off the Ventilator After TAVR with a Neurological Disease or Need a Tracheostomy?
If you want to know what is the best way to wean your dad off the ventilator after a transcatheter aortic valve replacement, stay tuned. I’ve got news for you.
My name is Patrik Hutzel from intensivecarehotline.com and I have another quick tip for families in intensive care today.
So today, I have an email from Rebecca who says, “Hi, Patrik. How can I wean my dad off the ventilator after the transcatheter aortic valve replacement procedure? He has a neurological disease. The doctors estimate there’s a 35% chance he will need a tracheostomy.”
So, Rebecca, I’m very sorry to hear about your dad’s situation. He’s very
challenging and I understand that you’re looking for guidance on weaning him off the ventilator after his transcatheter aortic valve replacement procedure.
So, as a general approach, it’s essential to follow what the doctors are specifically recommending for your dad’s care, especially when it comes to gradual reduction in ventilation support.
Process of weaning typically involves reducing the level of ventilator support gradually. Usually, patients start off in a controlled ventilation mode such as SIMV (Synchronized Intermittent Mandatory Ventilation) or ACV (Assist Control Ventilation) and then it includes lowering the pressure support. It includes lowering oxygen levels. It includes lowering the PEEP (Positive End Expiratory Pressure) sometimes, and then trial periods without the
ventilator, which are called trials off the ventilator or spontaneous breathing trials. Goal is to see how your dad tolerates breathing on his own, monitoring for signs of
fatigue, respiratory distress, or inadequate oxygenation.
Now, that only can really happen if your dad is stable. So, what do I mean by that? If your dad is, for example, after the transcatheter aortic valve replacement, if he’s bleeding, if he is in an irregular heart rhythm, if his blood pressure is low, or if his blood pressure is high, if he’s potentially developed a tamponade, if he’s bleeding,
then he won’t be weaned off the ventilator. So, I’m assuming he’s stable. He’s not on inotropes, he’s not on vasopressors, then he should be able to be weaned off the ventilator.
There’s a process when someone is weaned off the ventilator. I’ve made a video a couple of
years ago that are linked towards, “How to wean a critically ill patient off ventilator and the breathing tube?” I highly encourage you to check
that out.
Next, his respiratory status needs to be assessed. So, the medical team and the nursing team will assess his breathing pattern, blood gas
levels, especially oxygen and CO2 (Carbon Dioxide), and how well his lungs are functioning on their own. Given his neurological disease, the doctors will also be watching his ability to clear secretions and his overall respiratory drive.
Next, neurological consideration. Since your dad has a neurological condition, this complicates the weaning
process as his ability to protect his airway, maintain a normal respiratory drive, and manage his secretions might be impacted. The neurological disease might impact how quickly he can recover, so the team will likely be extra cautious.
Tracheostomy decision. The doctors are estimating a 35% chance of him needing a tracheostomy, likely consider the possibility of prolonged respiratory dependency, especially if it doesn’t show enough progress or if his airway is at risk of obstruction. The tracheostomy would help provide long-term respiratory support if needed. The decision will be based on whether he’s able to
maintain adequate oxygen levels and clear secretions without the ventilator. Like I said, it will also be dependent on whether your dad is hemodynamically stable, whether there’s no bleeding, no arrhythmias after the transcatheter
aortic valve replacement.
Next, multidisciplinary team. A team of specialists including pulmonologists, intensivists, neurologists, and respiratory therapists will likely be involved in the decision-making process. They’ll work together to determine whether weaning is feasible and whether a tracheostomy is required.
Next, monitor for signs of progress or setbacks. If there are signs of fatigue, difficulty breathing, or low oxygen levels, the weaning process may be slowed or paused. Conversely, if your dad is doing well without the ventilator, the team will continue to wean with gradual reduction. It’s very important to keep managing your dad very closely while he’s in ICU, doctors and nurses need to do that and adjust the plan on his response and conditions.
So, to summarize, wake up your dad. That’s also very important, I didn’t mention that. Wake him up, get him off sedation, get him off opiates or to minimize as much as
possible because opiates can also have a sedative effect. Then get him off inotropes, get him off vasopressors, make sure there’s no bleeding after surgery, and make sure he’s hemodynamically stable, no vasopressors, inotropes. He’s not in an irregular heart rhythm, then try and wake him up. As soon as possible, get him out of bed, get him mobilized as soon as possible
with or without a tracheostomy, ideally so it’s not ending up with a pneumonia. You certainly don’t want that.
So, I hope that helps and
answers your question there, Rebecca.
I have worked in critical care nursing for 25 years in 3 different countries where I’ve worked as a nurse manager for over 5 years in intensive care, and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy. We can do the same for you because our advice is absolutely life changing. You can verify that on our testimonial section at intensivecarehotline.com, and you can verify it on our intensivecarehotline.com podcast where we have done client interviews.
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Thank you so much for watching.
This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.
Take care for now.
