1. Ventilator Weaning in the patient with TBI Lakeview Specialty Hospital & Rehab Waterford, WI Robyn Rushing, RRT; Holly Sennet, SLP; Robert Rushing, CRT

2. 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.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.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.

3. 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.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.Brain function is temporarily or permanently impaired and structural damage may or may not be detectable with current technology.

4. 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.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.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.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.

5. Therapist Driven Protocols Patient Driven ProtocolPatient Driven Protocol Assessment ProtocolAssessment Protocol Ventilation ProtocolVentilation Protocol –Invasive –Non-invasive Conservative ventilation parametersConservative ventilation parameters –Minimizing pressure and lung injury –Improving oxygenation

6. Multi-Disciplinary Approach TherapiesTherapies –PT – Vent mobilization protocol –OT – Resuming ADL function asap –SLP – Evaluation, Communication, Swallowing and Education

7. Combining the Processes Weaning Protocol – advancedWeaning Protocol – advanced Early ambulation – advanced equipment and therapiesEarly ambulation – advanced equipment and therapies Regaining H.O.P.E.Regaining H.O.P.E. –Healing –Objective –Persistence –Encouragement Positive EngagementPositive Engagement –Care Givers –Family –Patient

8. Communication is Key Cognitive and Speech Therapy – The core of the patientCognitive and Speech Therapy – The core of the patient Giving the patient a voiceGiving the patient a voice –Patience is instrumental in achieving positive feedback Speaking valveSpeaking valve –Passy-Muir DynavoxDynavox –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 educationiPad Applications for communication, swallow and education –Phrase Board –Verbally –Speak IT –Assisted Chat –Dysphasia

9. Supporting Roles PharmacyPharmacy –Effective Sedation –Role of the clinical pharmacist (PharmD) –Stress, agitation and pain NutritionNutrition –CO 2 Monitoring –Carbohydrates –Electrolytes –Protein PsychologyPsychology –Patient –Family Case Management/Discharge PlanningCase Management/Discharge Planning

10. Case Study Discussion Male patientMale patient –Ventilator –Trach –Oxygen demands –Vocal cord paralysis

11. Success! Every case is uniqueEvery case is unique The commonality is our humanityThe commonality is our humanity This work is a calling…..not for everyone…but absolutely rewardingThis 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!Thank you for doing what you do to change the lives of others. It is a worthwhile pursuit…and worthy of recognition!

12. QUESTIONS ?