Discharge Planning and Ventilator Weaning

     Medical stability, sleep studies that rule out nocturnal hypoventilation, and a detailed home care plan are required to discharge ventilator-dependent patients. The home care plan:

• May require full-time, or nearly full-time attendant or nursing care for safety
• Requires hands-on training and a detailed home care manual for the patient, family members, and all responsible for care
• Requires the cooperation of local power companies, fire departments, and hospital emergency departments
• May require back-up emergency generators
• Requires alarm systems to alert to accidental disconnection, equipment malfunction, and mucous plugging of tracheostomy tube
• Requires ongoing case management services

      Long-term survival has been correlated with successful weaning from mechanical ventilation (Slack & Shucart, 1994). Two commonly used methods of weaning individuals with quadriplegia from mechanical ventilators are intermittent mandatory ventilation and progressive ventilator-free breathing (T-piece breathing), with one study demonstrating progressive ventilator-free breathing to be more successful and superior in its ability to provide a more functional alternative to individuals unable to wean completely (Peterson, et al 1994). In patients treated with test tubes and with injuries that typically allow weaning, surgery to correct lung adhesions, entrapment, or deformation at the former chest tube site, may be necessary for weaning (Peterson, et al 1994).

     However, long-term life satisfaction and well-being are at least as high, and sometimes higher, among ventilator-assisted individuals with paraplegia as among autonomously breathing individuals with tetraplegia (Bach & Tilton, 1994).