Ventilator Weaning in the patient with TBI


Ventilator Weaning in the patient with TBI

Lakeview Specialty Hospital & Rehab

Waterford, WI

Robyn Rushing, RRT; Holly Sennet, SLP; Robert Rushing, CRT

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.

• 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.

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.

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

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.

• 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.

Therapist Driven Protocols

• Patient Driven Protocol

• Assessment Protocol

• Ventilation Protocol

– Invasive

– Non-invasive

• Conservative ventilation parameters

– Minimizing pressure and lung injury

– Improving oxygenation

Multi-Disciplinary Approach

• Therapies

– PT – Vent mobilization protocol

– OT – Resuming ADL function asap

– SLP – Evaluation, Communication, Swallowing and


Combining the Processes

• Weaning Protocol – advanced

• Early ambulation – advanced equipment and therapies

• Regaining H.O.P.E.

– Healing

– Objective

– Persistence

– Encouragement

• Positive Engagement

– Care Givers

– Family

– Patient

Communication is Key

• Cognitive and Speech Therapy – The core of the patient

• Giving the patient a voice

– Patience is instrumental in achieving positive feedback

• Speaking valve

– Passy-Muir

• Dynavox

– 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 education

– Phrase Board

– Verbally

– Speak IT

– Assisted Chat

– Dysphasia

Supporting Roles

• Pharmacy

– Effective Sedation

– Role of the clinical pharmacist (PharmD)

– Stress, agitation and pain

• Nutrition

– CO



– Carbohydrates

– Electrolytes

– Protein

• Psychology

– Patient

– Family

• Case Management/Discharge Planning

Case Study Discussion

• Male patient

– Ventilator

– Trach

– Oxygen demands

– Vocal cord paralysis

• Every case is unique


• The commonality is our humanity

• This 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!