Long Term Ventilated Patients

For the majority of ill patients, mechanical ventilation is just a temporary therapy. They need a proper gas exchange to treat respiratory failure. But, in case of a critical illness or a serious health problem, patients will need more than just short-term therapy.

They will need constant treatment until they get better. That’s where long-term mechanical ventilation can come in handy. Here are all the things you can expect from a treatment like this.

Table of Contents

What is Long-Term Ventilation (LTV) Program ?

LTV is a specific program meant to provide patients with constant management and comprehensive consultation when they require long-term ventilation. Ventilator dependent patients must use a ventilator even at home.

Quick Facts

  • More than 4,800 children rely on invasive ventilation in the U.S.
  • Almost 11,000 Americans use long-term invasive ventilation.
  • The need for a tracheostomy tube skyrocketed from 8.3 per 100,000 population to 24.2 per 100,000 from 1993 to 2002.

Even though less than 10% of patients with respiratory problems need mechanical ventilation, they still take up 40% of the intensive care unit. Some need intensive hospital care before they can get back on their own two feet. Those with serious neurological disorders or progressive respiratory complications need lifelong support.

What Does the Program Offer ?

The goal of the program is to provide patients with optimal care and support their families on how to get through these difficult health issues.
Patients requiring mechanical ventilation have a lot to gain from a program such as this. They get to manage their respiratory problems and improve their quality of life. Each hospital dedicated to respiratory medicine has something unique to offer.

But, overall, you can expect to get:

  • Proper airway clean-up therapies
  • Outpatient and inpatient consultation
  • Caregiving training on how to use ventilator equipment at home
  • Help on how to coordinate the transition between home treatment and an intensive care unit
  • Collaboration with surgical and medical specialists
  • Consistently follow up with a patient requiring at-home treatment

Medical experts will focus on finding the best ways to manage any acute respiratory illness. That’s why they will use both inpatient and outpatient treatment. The role of rehabilitation is to help patients regain their health and function that they lost because of their respiratory issues. That way, they can breathe independently as soon as possible.

What’s the Typical Length of Stay in Hospital ?

The length of stay varies for each patient. It depends on how long they were mechanically ventilated and the type of respiratory complications they had, published the Critical Care Services Ontario. Based on their reports, patients who received mechanical ventilation for less than 21 days often stayed in the ICU for 5 to 6 days (average length of stay).

However, patients who received mechanical ventilation for over 21 days had to remain in the ICU for exactly 141,288 days.
Those who experience longer periods of in-hospital ventilation are known as LTV (long-term ventilation) patients. One study analyzed the hospital readmissions to find the risk factors that make LTV patients get readmitted to the hospital 6 months after their discharge.

Statistics show that the readmission depends on how long the patient has been staying in the hospital. It typically occurred in the first 39 days after the patient is discharged. The longer they’ve been on a ventilator, the bigger the odds for readmission. Overall, the readmission rate was 38%.
Luckily, specific respiratory therapy protocols can safely reduce the ventilator days by the number. Experts believe that spontaneous breathing trials (SBTs) can help with patient-ventilator dependency. Eventually, the patient could become a candidate for weaning.

Can Weaning Fail ?

Weaning failure is possible. If a patient can’t pass the spontaneous breathing trial or they need the tube to be reinserted in the first 48 hours after it has been removed, they’ve failed the weaning process. To reduce the risk of reintubation, doctors usually predict the success rate and try weaning only on patients who meet specific criteria. The good thing is, reintubation rates are relatively low. Just 10% to 15% of patients need reintubation.

Weaning for Ventilated Patients

Ventilator management aims to help get patients off the ventilator as soon as possible. However, 20-30% of patients have trouble weaning from invasive mechanical ventilation. Although this is a necessary process, weaning can be different for everyone.

Weaning is a process that liberates patients from ventilator support. It helps people regain their independence and start breathing on their own. It takes 40% of the entire mechanical ventilation process.

Doctors classify weaning based on how long it takes. You have a simple, difficult, and prolonged weaning process. Simple weaning is done at the first try, right after the ventilator has been removed.

The difficult process takes a little while longer. The ventilator can be removed 2 to 7 days after the assessment. For patients with more serious respiratory complications, weaning can be a prolonged process. It takes more than 7 days after the initial assessment.

How to Predict Weaning Failure ?

Some people are more susceptible to weaning failure. One of the most common predictors are:

  • old age
  • serious illnesses
  • long-term mechanical ventilation
  • fluid balance

Age is often the main cause of failure. But, if an older patient also has a disease, it might complicate the whole weaning process. According to animal studies, age reduces the diaphragmatic muscle function. These are the dome-shaped muscles found on the base of our lungs.
When these muscles can’t function properly, they are prone to serious complications. As a result, it becomes difficult for patients to adapt to independent breathing. Old age is also linked to anabolic resistance.

It increases the risk of muscle breakdown, especially after a person has experienced a serious illness. This will take a heavy toll on the lungs, which is why the older patients are more vulnerable to weaning failure. Other health conditions can also cause weaning failure. More than 50% of long-term ventilator patients have pulmonary disease. Because of it, the body needs to put in more effort to breathe, which weakens the inspiratory muscles.

Simply put, the condition of the patient’s respiratory system will determine whether or not weaning will be successful. Some of these health conditions that cause weaning failure are pneumonia, acute lung injury, interstitial lung disease, and pulmonary edema.
The length of mechanical ventilation can also affect the weaning process. Patients who’ve used a ventilator for a long time can be vulnerable to weaning failure. However, their success rates greatly depend on the cumulative fluid balance. Based on a clinical analysis, the fluid balance was a lot higher in patients after extubation. The cumulative fluid balance helped scientists predict the potential for extubation failure.

Conclusion

For patients with critical respiratory problems, mechanical ventilation is a vital treatment option. It can help manage the impact of respiratory failure and help the weakened respiratory muscles get back on track. The LTV program is designed to provide exactly that. But, only a medical expert can determine the outcome of the whole treatment. If a patient is on the right path to recovery, they will eventually be weaned off the ventilators and regain their independence. Although it seems like a highly invasive therapy, it has helped countless patients boost their quality of life.

Why Cambridge?

Cambridge Medical & Rehabilitation Center is the specialized provider for Long-term Care and rehabilitation services in the United Arab Emirates. With 2 main facilities in Abu Dhabi & Al Ain, which are designed in a rehabilitation and long-term care hospital with a capacity of 90 beds each.

Cambridge provides an interdisciplinary clinical approach for Long-term Ventilated patients which is customized for adults, adolescents, and children. The best rehabilitation services are not only our goal but our ultimate objective is to customize the care plan for each patient and make sure that the patient’s family and their members are integrated into the treatment plan.

Either you joined Abu Dhabi hospital or Al Ain hospital for any kind of our rehabilitation services or even for long-term care you will feel as if you are at #Your Second Home.

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