How do the nurses determine WHEN to take you off the vent?

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S

sonavogel

I've been doing a lot of reading here about the ventilator experience post-op, and it seems that everyone's experience is the same in one respect, at least: The vent stays in, whether you fight it or not, until the nurses determine that it's time to take you off. So my question is, if fighting and pleading and using hand signals and having your loved ones plead to have you taken off will not work, what is it that ultimately decides the nurses that you are ready to have the vent taken out of your mouth?

Best, Sona
 
My reply is not from my own experience but from something I noticed when my father had a bypass operation. There was a machine attached to the vent which showed the number of breaths taken naturally as opposed to the ones given by the vent. I would assume that they wait until the patient is breathing 100% on his or her own. Don't ask me how the patient breathes on his own with the vent in, but apparently it can be done.

I am sure that there are others who know a lot more about this than myself.
 
Nurses don't determine when you're ready to be taken off the ventilator. Almost all critical care units have protocals that are followed to determine when a patient can be safely weaned off the ventilator. The idea is that weaning should be a methodical, evidence based procedure; not one that is subjectively determined by the medical staff, or even the surgeons. Having said that, surgeons, anesthesiologists, and pulmonologists can make the determination, but only if they have ventilator privileges in the ICU.
 
sona, don't worry, it's not always like that.....
I started to wake up in recovery and within minutes a nurse had come over and loaded me with morphine.
I believe I only woke up the next day, I was in step-down care and without a tube:)
 
Adrienne said:
My reply is not from my own experience but from something I noticed when my father had a bypass operation. There was a machine attached to the vent which showed the number of breaths taken naturally as opposed to the ones given by the vent. I would assume that they wait until the patient is breathing 100% on his or her own. Don't ask me how the patient breathes on his own with the vent in, but apparently it can be done.

I am sure that there are others who know a lot more about this than myself.
Click to expand...
Yes, Adrienne, breathing is possible.
we had to make a decision to take my mother off of life support.....the vent was left in and disconnected, she still breathed on her own for 5 hours.
 
I don't even remember the vent tubes. I had to be sedated twice - once for the AVR, followed a few hours later with a second dose from a different anesthesiologist before a second surgeon handled a relatively minor bleeding problem.

By the time I woke up, the vent tubes were already gone. I have had several other people tell me that they do not remember the vent tubes either.
 
Sona don't concentrate on things that you cannot control. I don't mean that in a mean way either, so please don't take it as such. When the ICU Pulmonologist or other physician are satisfied with your vent stats and you are breathing on your own, they will remove it. You will be so well drugged that you may not even remember it at all. It's not something where you wake up and your alert as can be, it just doesn't happen with all the anesthesia and drugs that you'll be given. Take it easy on this one. It's not as bad as you imagine.
 
I believe that the criteria for removing the vent tube is "when the patient can breathe on his / her own", but that still doesn't answer your question of HOW they know.

Conditioned athletes and people whose lungs are in good condition prior to surgery often hve their vent removed before they come to. Being a Non-Smoker helps.

FWIW, my vent was removed before I became aware of my surroundings, both times.

'AL Capshaw'
 
The ventilator keeps track of your inspired 02, output CO2, and other gases as well as counting breaths. It's a large computer lung. When the figures are in normal range for you, off you come.
 
Sona, don't worry. You know it will be there and you're prepared; it won't be a surprise.

It isn't a big deal. The tube is in, you're aware of it, but you're doped up a lot more than you think you are at the time. I remember it being in and I remember communicating with my wife by hand signals. It came out quickly and I only a very vague recollection of it coming out. Frankly, I was so happy the surgery was over and successful, and that I didn't have any pain, that I didn't care about the tube.

You will do great.

John
 
Ross said:
The ventilator keeps track of your inspired 02, output CO2, and other gases as well as counting breaths. It's a large computer lung. When the figures are in normal range for you, off you come.
Click to expand...

Here are the values used to determine when a patient is weaned from a ventilator.

A negative inspiratory force greater than negative 25
A tidal volume of 4 cc per kilogram per ideal body weight
A forced vital capacity of approximately 8-10 ml per kilogram per ideal body weight
And, a RSBI (rapid, shallow breathing index) of less than 90

As everyone has said, don't worry too much about it. The medical staff is just as anxious to get you off it as you are to get off it!:p
 
Mary, you're a doll--not that I know what the hell any of it means, but it obviously means a great deal when you're in the ICU.

I think I'm going to do a cut and paste of the stats and have a T-shirt made (size XL) of them, for my husband to hang on to--and to drape over me (as best he can) when he comes to yell (or whisper) in my ear that I've come through--if/when that times comes, that is!)--just to give the nursing staff a laugh. :D :p

Ice chips!! :D
 
They do blood work on Justin.I forget right now what they look at.But he has been awake and communicating, but not ready.BUT It is much better to wait until all the criteria are met, even if it sems to tak a little longer than to have to be reenbubated, because you came off it too soon. Justin's surgeons try to have him off the vent before he leaves the OR, sometimes he has been off it before we saw him and others he was on it for a few hours in CICU, (which he does remember,)
 
Sona:

I was on the vent for several hours in ICU (there was a clock on the wall in front of my bed, so I knew it was several hours).

My husband says he doesn't remember being on the vent. A nurse took it out about the time he got to ICU. I'm not even sure I remember seeing him on the vent. I remember being very surprised he was extubated so soon after surgery. (Went down to surgery after 2 p.m., maybe 2:30; was in ICU about 7:30-7:40 p.m.)
 
I have no memory of coming off the tube or waking while still on it. Thankfully.

I do wonder though.... many of us here have had other surgeries aside from OHS. Doesn't all major surgery require entubation? I had two abdominal surgeries in years past and must have been entubated for them but have no memory of it then either.

Is it because we are entubated longer with OHS than for other surgeries that it is such an issue for us with heart sugeries vs. other major surgery?
 
Jkm7 said:
I have no memory of coming off the tube or waking while still on it. Thankfully.

I do wonder though.... many of us here have had other surgeries aside from OHS. Doesn't all major surgery require entubation? I had two abdominal surgeries in years past and must have been entubated for them but have no memory of it then either.

Is it because we are entubated longer with OHS than for other surgeries that it is such an issue for us with heart sugeries vs. other major surgery?
Click to expand...

I believe the answer is yes. I had a vent for my laproscopic gall bladder, which i didn;t even realize until they were getting ready to take me down then remember briefly waking up for like a second feeling like i was choking, then remeberring oh that right they said they were going to entubate be that must be what it is and going back t sleep. I think it is more of an issue for heart and other surgeries where there are chances of waking up on them for hours or days ,most surgeries that don't involve heart, lungs don't seem to have you wake up while still on the vent.
 
Oh...I have memory of being on the vent tube after my last surgery....

Heh ... so much mucus had built up in my lower throat that, at the time, I remember I thought to myself: 'Great! I made it through the surgery with flying colors, but now my own mucus is going to kill me.'

Obviously, that didn't happen ;).


I remember they kept telling me I had to "pass a test" before they could take it out. I passed on the 3rd try ;).



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J was concerned about the tube after reading about other's experiences, but I have little memory of it. The experience of seeing me on the tube was much more traumatic for my wife. She tells me that I fought it by attempting to gnaw through it. My effort got me some bite blocks and ultimately a broken tooth, but the drugs they kept me on evidently kept me from remembering anything about it.

My first clear memory of the ICCU experience was when my nurses asked me if I was ready to go to the step-down unit. As others have stated, you'll come through this aspect of the recovery process with little problem. The ICCU team will get you through it.

-Philip
 
Seems I never tire of reading of others' experiences--and not just of the vent tube, but of all other aspects of the immediate recovery process. The vent tube is one of the first memories, it seems, so it becomes a sort of "marker" of how the rest will go. If I can make a point internally of converting the vent experience from something to fight into something to embrace (as best I can), that might set me up properly from the start.

Reading how others have coped helps to give me ideas. :)

Working as vigorously (and diligently) as possible with the breathing blowers (what are they called?) that help dry out and strengthen the lungs is another thing I'll set up as a task for myself.

Oh, there's quite a list I'm beginning to create, thanks to everyone's input! :D
 
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