Research

Research
• Prolonged Ventilator Weaning
• Vent Weaning:
  Quality of Life
• Psycho-Social
  Aspects of Weaning
• Other Weaning Studies

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Other weaning studies

Can Mechanically Ventilated Patients Feel Secretions in Their Airway?

Airway suctioning in ventilator-dependent patients can result in life-threatening complications. Patients are frequently asked if they want their airway suctioned; yet there is no evidence that patients can accurately sense whether or not they have secretions.

To study a patient's ability in detecting secretions, we asked 17 mechanically-ventilated patients the following questions: "Do you feel you have secretions or mucus in your airway or chest?" and "Do you want to be suctioned?".

Nine patients had a sensation of secretions and eight did not. All but one of the nine patients who felt they had secretions wanted to be suctioned; none of the eight patients who did not feel secretions wanted to be suctioned (p=0.004). The weight of the secretions suctioned from patients was greater in patients who sensed their secretions than patients who did not sense secretions (2.8 ± 3.3 vs. 0.06 ± 0.3 gm, p=0.05). Using one gm as a threshold for significant secretions, the sensitivity of patients sensing secretions was 83% and specificity was 70%.

The patients were also asked "Was suctioning very uncomfortable, uncomfortable, or not uncomfortable?" Seven answered "not uncomfortable", six answered "uncomfortable", and four answered "very uncomfortable". When patients were asked "How does your chest or breathing feel after suctioning?" seven answered "no change" and 10 answered "better." These answered were not related to the patients' feeling of secretions, wanting to be suctioned, or the amount of secretions.

In conclusion, ventilator-dependent patients can accurately sense secretion in their airway and they rarely experience severe discomfort from suctioning.

A Cohort of Ventilated Patients with West Nile Virus Infection

Outcomes of patients requiring mechanical ventilation for flaccid paralysis and acute respiratory failure caused by West Nile virus are unknown. We identified 11 such patients (27% female) who were transferred to a long-term acute care facility for weaning from prolonged mechanical ventilation. Average age was 62.8 ± 12.2 years. Common features on original presentation were weakness (100%), altered mental status (73%), fever (64%), myalgias (55%), headache (55%), and meningismus (27%). Of the 11 patients, five (45%) were weaned, three remained ventilator-dependent, and three died. Of survivors, one was discharged home, six were transferred to an acute rehabilitation facility, and one to a skilled nursing facility.

Maximum inspiratory pressure, measured in five patients on arrival to the facility, was 41 ± 25 cm H₂0. Successfully weaned patients had lower APACHE II scores on arrival at the facility than did patients who failed weaning or died (12.5 ± 4.1 vs. 8.4 ± 4.3; p=0.02). Duration of mechanical ventilation in patients who successfully weaned was higher than in a group of historical controls (62.4 ± 32.3 vs 37.6 ± 9.6 days, p=0.06). In-hospital morality was 27%—comparable to mortality of 31% for patients requiring prolonged ventilation at a long-term-acute care facility (Chest 2002; 122-37S).

In summary, patients with flaccid paralysis and respiratory failure secondary to West Nile virus require more time for weaning than an average patient admitted to a long-term acute care facility, although mortality and rate of weaning are comparable to the average patient in such a facility.