There’s no question that mechanical ventilation has saved countless lives. It provides life-sustaining oxygen for patients who can’t breathe on their own – but weaning them off of a ventilator is a challenging task that requires a variety of skills, technologies, and teamwork.
Hospitals today are developing more effective weaning protocols while ventilator manufacturers are creating improved technology that helps better reach the goal of restoring full breathing function in patients whenever it’s possible. Here’s a look at the many factors that emphasize the importance, and challenge, of ventilator weaning.
The Challenges of Ventilator Weaning
Sedation is a fact of life for most patients on long-term ventilation, but sedation can prolong dependence on the ventilator, as well as impact cognitive functioning. Some doctors suggest using non-sedating medications, which allow for earlier weaning. The impact of heavy sedation includes not only cognitive effects, but also can result in long-term neurologic issues, and even post-traumatic stress disorder.
One of the challenges with sedation, however, is that it can affect every patient differently. Research has shown that patients who are typically calm in normal life will most likely remain calm on a ventilator, while patients who struggle with issues such as drugs, alcohol or anxiety issues can have more problems while on ventilation.
Another factor that has been shown to help hasten weaning is mobility. Hospitals that stress early mobilization programs for patients on ventilators have seen good results. It’s healthy for both the mind and body; in fact, the muscles in the diaphragm weaken because they don’t have to do any of their normal work during ventilation. Moreover, all of the muscles can weaken because they’re used much less than they were prior to the patient’s illness, and combined with sedation can result in weakness after just four or five days on a ventilator.
The scientific community has made great strides in the past decade in terms of developing technology that prevents or limits complications associated with mechanical ventilation. Additionally, both safety and workflow have been improved to help enhance the ICU environment.
Additional improvements, such as the addition of microprocessor control and electronic medical record systems, have helped advance technology, as well. In general, devices today are more sensitive to patient interaction while capturing important patient clinical data. And having ventilator data remotely available provides access to clinicians with the necessary tools to make important decisions – whether they’re at the patient’s bedside or not.
The Importance of Teamwork
The process of successfully weaning a patient off of a ventilator is best served by a team approach that includes respiratory therapists, nurses, physicians, physical therapists and other clinicians. It’s important that all parties involved stick with protocols that may have been established by the respiratory therapist. Protocols also need to be reviewed periodically and compared with hospitals of similar size.