How Can My 9-Month-Old Baby Be Weaned Off the Ventilator & Tracheostomy in PICU? Can She Go Home?

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How Can My 9-Month-Old Baby Be Weaned Off the Ventilator & Tracheostomy in PICU? Can She Go Home?

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Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies and where we also provide tailor-made solutions for hospitals and intensive care units whilst providing quality care for long-term ventilated adults and children with tracheostomies, otherwise medically complex adults and children at home, which includes Home BIPAP (bilevel positive airway pressure), Home CPAP (continuous positive airway pressure), also home tracheostomy care for adults and children that are not ventilated, also Home TPN, Home IV potassium infusions, Home IV magnesium infusions, Home IV antibiotics. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheter) line management, as well as Hickman’s line management, as well as palliative care services at home.

Now, in today’s blog post, I want to answer a question from Sonia. Let me read out the question from Sonia who says,

“Hi, Patrik,

I have my nine-month-old baby girl in intensive care. She had four failed extubations. So, she had to have a tracheostomy and has been stuck on a ventilator since May last year. Her respiratory rate has been high since birth. When she’s asleep, it’s between 50 to 60 breaths per minute, but when she’s awake, it’s anything between 70 to 90 breaths per minute. She currently has a PEEP of 10, and pressure control and pressure support of 6, respectively. Do you have any advice on how we are able to wean her off? She has no airway issues; CT scan was okay. The only thing that the doctor say is that her lung volume is less than a baby her age.” Thank you so much, Sonia, for sending through this question.

So well, first off, you need to establish what ventilation setting she is in. Is she in a controlled ventilation mode such as SIMV (Synchronized Intermittent Mandatory Ventilation) or ACV (Assist Control Ventilation) where the machine is delivering a set number of breaths per minute, or is she in a CPAP or pressure support ventilation mode where she’s triggering most of her breaths herself? Is she passing any spontaneous breathing trials? You haven’t elaborated on that. Has she been off the ventilator at all? Even if it’s only for 5 or for 10 minutes, even that would be a starting point.

In terms of weaning your daughter off the ventilator, it should be similar. It’s not dissimilar to many other adult patients; mobilization, stopping sedation, stopping opiates. Mobilization would be first and foremost, reducing PEEP, reducing pressure support, reducing oxygen levels as much as you can and getting her to breathe on CPAP pressure support more and more. Once she can do that, more than 24 hours a day, put her on a T-piece and see what happens.

Now, if that can’t be achieved, other strategies here could be lung volume is decreased. She could potentially have a tracheostomy. Many ICUs are doing that, do a bronchoscopy which is putting a video camera down in the lungs and see what’s going on there. Also, with lung volume being decreased, why is that? Is she having secretions? Why is lung volume decreased? Was she prematurely born? Are lungs affected, not developed? You haven’t elaborated on any of that, but those would be things that I would be asking them and see what the answers are.

If your daughter cannot be weaned off the ventilator, then clearly the Intensive Care at Home is the best next step.

Continue reading at: https://intensivecareathome.com/how-can-my-9-month-old-baby-be-weaned-off-the-ventilator-tracheostomy-in-picu-can-she-go-home/