Ventilator Weaning at Whittier Rehabilitation Hospitals

What is ventilator weaning?

Ventilator weaning is the process of gradually reducing the support provided by a ventilator to a patient who is unable to breathe independently. It can be challenging, but gradually allowing the patient’s body to regain strength and function is vital.

Who needs ventilator weaning?

Any patient who requires ventilator support due to respiratory failure from an acute or chronic illness, trauma, and/or complications from surgery or progressing neuromuscular disease.

What’s different about ventilator weaning at Whittier Rehabilitation Hospitals?

• At Whittier, we approach weaning as a team. Our teams are composed of pulmonologists and respiratory therapists with various training in acute care, LTAC, skilled nursing, and home care. We work together with all disciplines to ensure the safety, education, and best outcomes for our patients. 
• Our team also includes nurses, speech therapists, physical therapists, occupational therapists, and dietitians to best meet the needs and goals of our patients who need ventilator support.
• We can also help the patient transition to home if long-term ventilator care is necessary for them. We educate and support the patient, family, and caregivers to provide for their loved ones at home. We have a specialized Pulmonary Program that is certified through The Joint Commission.

At Whittier, we offer a multidisciplinary approach to vent weaning.

• A multidisciplinary approach means that we work with physical and occupational therapy to help patients rehab and build strength in the gym (even on a ventilator) and/or in their room to help enhance mental and physical well-being.
• We work with speech therapy to help with communication and vocalization for those patients who require a tracheostomy so that we can progress to decannulation (removal of the tracheostomy tube.)
• We work with the dietitian so that the patient has the proper nutrition to help build muscle strength while weaning from the ventilator and exercising.
• We meet daily with the pulmonologists, hospitalists, and physiatrists for plans of care to safely wean patients and provide education and resources for improved outcomes.

How the vent weaning process works

Respiratory therapists will initiate weaning trials every day under the orders of our pulmonologist and extend the duration of weaning as tolerated until the patient is able to become independent off the ventilator. Therapy is scheduled daily with each discipline to meet short-term goals, and weekly for longer-term discharge goals. We will adjust therapy and education to meet the patient’s needs and goals.

At Whittier, we use all modes of ventilation and weaning support, such as PSV, SBT (spontaneous breathing trials to assess the ability to wean from the ventilator), and trach collar trials (complete independence from the ventilator). These are scheduled every day to determine the ability to increase the time of weaning until the patient achieves their goals.

There are three main types of ventilator weaning techniques:

• Spontaneous breathing trials (SBTs): During an SBT, the patient is disconnected from the ventilator and allowed to breathe independently. The time the patient can live without the ventilator gradually increases over time.

• Pressure support ventilation (PSV): PSV is a type of ventilator support that provides the patient with additional pressure to help them breathe. The amount of pressure support is gradually decreased over time.
• Tracheostomy mask: Independence from the ventilator using oxygen and humidification.

The weaning process typically starts when the patient’s underlying condition has improved, and when they can breathe independently for short periods. The patient’s progress is monitored closely, and the weaning process is adjusted as needed.

We are a leading provider of ventilator weaning services.

Whittier Rehabilitation Hospital is a leading provider of ventilator weaning services. The hospital’s experienced respiratory therapists and nurses work closely with each patient to develop a personalized weaning plan. The hospital’s success rate is 99%, significantly higher than the national average.

Conditions we treat at Whittier:

• COPD, which may include chronic bronchitis, emphysema, asthma, bronchiectasis
• Pneumonia
• Complications after surgery
• Worsening chronic conditions resulting in respiratory failure
• Stroke/CVA
• OSA/OHS (obstructive sleep apnea, obstructive hypoventilation syndrome)
• Neuromuscular diseases
• Trauma resulting in respiratory failure
• Interstitial lung disease

Ventilator weaning can be challenging, but it is possible to be successful. With the proper support and motivation, you can overcome this challenge and breathe on your own again.

Here are some tips for a successful ventilator weaning:

• Be patient and persistent. The weaning process can take time, but it is essential to stay positive and motivated.
• Work closely with your healthcare team, who will be able to provide you with the support and guidance you need.
• Be prepared for setbacks. There may be times when you need to take a step back and reassess your progress, which is normal and does not mean you cannot wean from the ventilator.
• Stay active. Exercise can help strengthen your respiratory muscles and make breathing easier.
• Get enough rest. Your body needs time to heal and recover.

What comes after ventilator weaning?

At Whittier Rehabilitation Hospitals our goal is to stabilize our patients during the vent weaning process while in LTAC, so that they have better outcomes upon discharge from the hospital. For those patients that may need additional therapy upon discharge from our LTAC unit, our network offers a transition to one of our in-house acute rehabilitation units, our transitional care units, or one of our six skilled nursing facilities, for post-ventilator support and treatment.  For those that make it home, we also have a comprehensive pulmonary program offered on an outpatient basis.

Nationwide, LTAC closures have sent more tracheostomy patients to nursing homes, but many are not ready. A recent article outlined the situation. Whittier is trying to combat this issue by offering the entire continuum of care for our patients.

Our team’s clinical expertise enables them to design an individualized care plan for each patient. We put equal emphasis on improving function and planning for the transition to tracheostomy independence, for the best chance at long-term success.

If you or a loved one is being treated for ventilator dependence, Whittier Rehabilitation Hospitals can help. Contact one of our hospitals today to learn more about our ventilator weaning services.

Resources:

• Contact Bradford Rehabilitation Hospital
• Contact Westborough Rehabilitation Hospital
• Refer A Patient