“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.