1. Ventilator Weaning in the patient with TBI Lakeview Specialty Hospital & Rehab Waterford, WI Robyn Rushing, RRT; Holly Sennet, SLP; Robert Rushing, CRT

2. 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.

3. 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.

4. 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.

5. Therapist Driven Protocols • Patient Driven Protocol • Assessment Protocol • Ventilation Protocol • Invasive • Non-invasive • Conservative ventilation parameters • Minimizing pressure and lung injury • Improving oxygenation

6. Multi-Disciplinary Approach • Therapies • PT – Vent mobilization protocol • OT – Resuming ADL function asap • SLP – Evaluation, Communication, Swallowing and Education

7. 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

8. 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

9. Supporting Roles • Pharmacy • Effective Sedation • Role of the clinical pharmacist (PharmD) • Stress, agitation and pain • Nutrition • CO2 Monitoring • Carbohydrates • Electrolytes • Protein • Psychology • Patient • Family • Case Management/Discharge Planning

10. Case Study Discussion • Male patient • Ventilator • Trach • Oxygen demands • Vocal cord paralysis

11. Success! • 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!

12. QUESTIONS ?