Getting off the respirator

[JenniferO]

I have a question prompted by Ross' struggle to get off the respirator.

Another heart patient with whom I corresponded and ultimately met in Cleveland told me she had a terrible time getting off the respirator because she couldn't "pass the test". She was on it for way longer than she felt was necessary because whatever "test" was being used was something she kept flunking and the nurses kept misreading her signals. Is there any possibility this is happening with Ross. Could his struggles be trying to communicate that he doesn't need this damned thing anymore but no one is hearing/seeing this?

What measures do they use to know when the patient is ready?

I was extremely lucky; when I came to consciousness in the ICU the respirator was gone.

 

[Nancy]

I'm not exactly sure, but I think they turn it off from time to time to see if you can breath on your own. I suppose it's also possible that they want his heart, aorta and lungs to heal really well from surgery and are keeping him on the vent a little longer than normal.

Don't forget that he had several surgeries at once, heart valve replacement, partial aorta replacement, removal of cyst from the pericardial wall and lung repairs, then they did the hernia repair. No wonder this man was feeling so poorly!

That's a load of surgery all at once. He's got an awful lot to heal from. I feel in my heart that Ross will be OK. He's strong and he knew going in that it wouldn't be a cake walk. Here's a quote from Steve's original post re: his dad's surgeries:

"Dad went in around 5:30am, and the heart surgery started around 7:00am. Dr. Novoa did the job, as he replaced a small part of the aorta, and inserted a mechanical (St. Jude) valve. What was at first believed to be a blood clot in the heart turned out to be a cyst on the ride side paracardial wall, removed that. While in there, Dr. Novoa found that the left lung had 2 Blebs (leaking air), and they were removed. We were informed that his left lung will cause trouble in the future, with the possibility of removing the lung. This successful procedure lasted around 6 hrs."

God love you, Ross. You're going to be OK. Rest and heal well. We'll be waiting to hear this whopper of a story.

 

[dkader]

Ross & how to get off respirator

Ross & how to get off respirator

Jennifer O. has asked me to possibly help out Ross in getting off the respirator. I was supposed to have been taken off right away after surgery as I was breathing on my own (according to Dr. Cosgrove), but it was a long 7 hrs later with no pain meds given. I should have been blissfully medicated & resting but was way too aware of phone calls, surroundings, pain, etc.

There were two tests they tried to give me to see if I could get off (even though the dr said I could). They would unhook my breathing tube and have me suck on another tube. The 1st one I got air but the 2nd one I got nothing & felt like I would suffocate and gave up. They tried a few times but wouldn't take me off and neve explained how to pass the test or what to do other than to suck on it. After 7 hrs & a shift change they just took it out.

When I mentioned this the next day to the ICU nurse, she told me I wasn't supposed to get air on the 2nd test - that it is only a measuring device. So, the moral of this story is to suck as hard as you can, even though you don't get any air. I pray by this time that Ross is off that thing and on his way to recovery! I hope this helps in some way to anyone.

 

[joy]

You know, Jennifer has a point, I thought it was rediculous that they made me sit and gag on the stupid ventilator, and wouldn't take me off it until I quit choking on it. Of course you are going to choke, it's SHOVED DOWN YOUR THROAT! They kept telling me to relax, but it's kind of hard to. I feel so sorry for Ross! They took me off it after two hours of struggling, but Ross has been on it for days, I can only imagine how he's feeling. Poor guy. I wish I could go and visit him, but I live too far away.

 

[Hank]

Ventilator Weaning Parameters

Ventilator Weaning Parameters

This is one subject I happen to be an expert on (there aren't many like that).

To see if a patient is ready to come off of a ventilator, the physician (usually the anesth doc) orders what are called "weaning parameters". These parameters are then measured with the tests I will mention below.

They don't have to be done in this order.

NIF - Negative Inspiratory Force: This is the test where they pop you off the ventilator and "plug" the tube. They actually plug it with a pressure manometer that measures the amount of force with which you try to inhale. This measures how strong your inspiratory muscles are and it usually must be at least -30mm of mercury (a unit of measure)

MV - Minute ventilation: This is a test that measures the total volume of air that you exhale in 60 seconds.

VT - Tidal Volume: This is the total amount of air that you exhale with one breath. The number they aim for is based on your height.

There are other tests like measuring your respiratory rate and such. They also like to wait until you can maintain a high oxygen saturation while on as little as possible extra oxygen. Your carbon dioxide levels are also measured.

For 10 years I was the respiratory therapist that performed these tests and operated the ventilators that keep us all alive when we can't breathe on our own.

I would be happy to answer anu other questions anyone may have regarding ventilators because this is one area in which I am knowledgeable.

 

[JenniferO]

Thanks Hank for the knowledgeable response.

In Denise's case, it was the first test you describe that created the problem. Since she thought she was supposed to get air out of the second tube, she didn't try to "suck" hard enough but gave up and shook her head at the nurse to indicate that she wasn't getting air. Apparently the nurse interpreted it as "I can't suck" and commented "she can't do it" and left her on the vent.


Since Ross is no stranger to the vent from previous surgeries, hopefully he understands these tests and what is expected of him.

 

[Hank]

Bozo Nurse

Bozo Nurse

The idiot performing the test is of course supposed to explain in detail what they are doing. That is unfortunate.

 

[dkader]

Thank you Hank for explaining!

Thank you Hank for explaining!

Dear Hank,

Thank you so much for explaining the process of weaning off the respirator. You are so right when you say the idiot performing the procedures should explain it.

That was my only complaint about my stay at Cleveland Clinic - no one before, during, or after explained anything about these tests, except one nurse who said I wouldn't get any air from the one tests.

My biggest fear going into surgery was being left on a ventilator and I told my husband to make sure I got off it asap. Only the nurses had told him to go home and the doctor had already told him they would be taking me off right away, so he wasn't worried. And, like I said before - I was painfully awake and very aware of my surroundings - I don't even think I fell back asleep until they finally gave me meds after taking it out. Oh, they also told me I would have to lift my head up to take it out and I felt like I'd been hit by a truck and couldn't do that either. I just wish they would have explained. I try to tell people beforehand now, so at least they know.

 

[Nancy]

HI Hank-

Thanks for demystifying the vent. We have so many terrific experts here. It helps a lot!

 

[John Cochran]

Ross had mentioned in an earlier post that he has been sedentary for quite a while. With all his surgeries, and some diminished aerobic capability, it's not surprising that it's taking a while to wean him off the vent. I was surprised today to realize I've been thinking about Ross and his family about every five minutes. Amazing how one man has reached out and touched so many people. Get well soon, Ross; we miss you.

--John

 

[LUVMyBirman]

Hey Hank,

How's it going?
Thanks for the detailed clarification.
Prior to my MVR I read that waking up to the 'ventilator and associated in your throat was the worst part of the beginning stages of recovery. I have no recollection of the ventilator, though my family said it was in place in the ICU for a few hours.

Hope Ross can rid himself of the tubes very soon.