C6 injury EXTUBATED!!

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curiousgeorge
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C6 injury EXTUBATED!!

Postby curiousgeorge » Sun Nov 13, 2016 2:19 pm

Our patient still has a c6 level. After about 2 weeks of ventilation on 21% O2 with cough assist and high PS I extubated her today. She did very well during the day on mouthpiece ventilation and required only occasional MIE. We will put her on mask ventilation for the night. I put her on PS 20 equivalent through the mouthpiece and AVAPS 18 bpm for the night. How would you recommend continuing to wean from ventilation? Decreasing pressure (the normal way) or allowing the patient to use the mouth piece less as she wishes?

She complained of a very dry mouth from the mouth piece, so I put a heater/humidifier into the circuit which seemed to help.

I have a couple of questions:

1) I found very little research on cough assist in the general ICU population. It seemed to help, but there seem to be almost no randomized trials or good outcome studies. Do you know why?

2) Most ventilation recommendations suggest the exact opposite of the cough assist approach. They recommend limiting peak pressure, using low TV and maintaining PEEP to try and maintain the FRC. The cough assist approach uses higher pressure, high TV and with the negative pressures can de-recruit the lung. Does this suggest to you that the cough assist approach should be limited only to patients who do not have inflammatory lung disease, or would you use cough assist widely?

3) If I can answer my own questions (!!) I would like to try using cough assist in all patients who are weaning, especially those whose cough seems ineffective. Would you suggest use in other acute populations?

(Asked by a physician)

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bachjr
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Re: C6 injury EXTUBATED!!

Postby bachjr » Sun Nov 13, 2016 2:22 pm

John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School

LassenLaw
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Re: C6 injury EXTUBATED!!

Postby LassenLaw » Thu Dec 15, 2016 8:59 pm

@bachjr thanks! That is a very good and complete explication .


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