Any advice on ventilation weaning for my Mom who has COPD and just had surgery?

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My 82 year mother who has chronic COPD, felland broke her hip. Surgery went well, but they are having difficulty weaning her off the ventilator due to her lung condition. Even though my mother has a DNR and DNI in place, the ventilator was used as a post operative procedure. Now I am in a dilemna as to continue ventilator assistance or honor my mother's wishes. If any one has any experience with this situation, I would really appreciate some input. She has been on the ventilator assist and sedation for 5 days and still cannot breath totally on her own.

Answers 1 to 10 of 10
Is she making progress? As long as she is getting a little better everyday, work with Respiratory Therapy. If you see her on a backslide, if the kidneys and liver are shutting down, if the heart monitor is going into alarm, and her responses are weakening, respect her wishes.
Vitals good except ability to breath with out assist from ventilator except during trial periods of her breathing on her own with a push assist from ventilator which has increased each day in duration. No liver or kidney function problems so far. Doctor mentioned possible Tracheotomy and tube for possible ventilator weaning. Could possibly become permanent. My mother would not want to live like that. Heart rate only increases dramatically when there is no respirator assist. Was switched to a midline cathater iv in arm. Am I doing the right thing by her or do I say enough is enough and let her go.
Just my opinion based on experience with my father, but I think it's way too early to give up. My father was a lot sicker at 85 than your mother is and he made it, even though he had some rough times.

One ICU nurse and a pulmonary doctor both told me he'd never live, but even if he did he'd never get off a ventilator and would never walk again. When he was extubated and walking, we ran into that doctor at the hospital and I reminded him of his dire prognosis. He joked about it rather than admitting how wrong he was.

Dad was on a ventilator for 6 months, having initially been intubated then trached after about a week or so because of the potential damage a ventilator can cause. I think the possibility of a trach indicates that the doctor is thinking of a longer term weaning, but that doesn't necessary mean that the situation is dire enough to make a more drastic decision.

Over the long period of being trached, my father lost total ability to swallow and had to be weaned not only from the ventilator but had to learn how to swallow w/o frank aspiration. That process took several months.

What might be suggested by the medical team is a placement in what's known as a long term care hospital; it's a hospital but the focus is on patients who need a level of care higher than a SNF can provide. Select Speciality was the hospital we chose.

When you wrote that the doctor mentioned a possible tube, I assume you're referring to a stomach tube by which your mother could receive nutrition? It actually sounds worse than it is and would provide her with enough nutrition to stabilize as she weans from the vent.

I assume that the sedation administered is keeping her more or less unconscious and she's not able to communicate her feelings now?

One thing I did when my father was at his worst was to play music for him (CD player) and sing his favorite hymns. I watched the BIS monitor while I did that and noticed an increase in brain functions. Even one of the ICU nurses said he was responding to the music.

I read sometime ago that Israeli doctors used music to bring patients out of anesthesia after surgery. I've seen enough people respond to music to have a strong belief that it can be very, very helpful.

Good luck, and be sure to take some time out to do something other than focus on this issue as you'll be able to think clearer and more comfortably with some good rest and relaxtion for yourself.
If the dr is talking about a trach he is thinking is long term, I am an RT in an ICU, we normally start the trach talk after 10-15 days of intubation. A trach is an artificial airway.. her DNI indicates she would not want this.My Mom was taken to the hospital last year, refused to back down on the intubation, and although it was hard I had to go with her wishes. She rallyed, but I would have to make the same choice again.. she is mentally aware and knows what she wants.. and is is retired nurse. The vent is comman during surgury, but it;s use after is either short term or not.When it is looking long term your must respect thier whishes. Sometimes what is what WE want is not what they would want. Would she want to be in a rehab long term? COPD is not going to get better. Sorry if this sounds hard, I don;t mean it to. But if I had a DNI/DNR that would be what I meant!
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Thank you every one for your answers, especially from pamzimmrrt. Having straight foward information from those in the field of Respratory medicine and first hand experience gives me the reality of what to expect. I know for a fact my mother would not want a trach nor go through 6 months of this nightmare. Her biggest fear was losing more quality of life than she had. Doctors are taught to heal under cenrtain protocols without thinking about what the patient wants or would want. This is an agonizing decision I am dealing with. Wish there was a crystal ball.
Army retired what ever happend to your Mom was she able to get off the vent? I am in in a similar situation now and I am looking for guidance. thanks.
Msdaisy..Have the doctor considered a BiPap machine. When a patient takes a breath, the machine gives them an extra push of oxygen to help the lungs get more air deeper inside. My mother did not want to be placed on a respirator because of her COPD/Asthma so we tried the BiPap. 24 hours later she was significantly improved. The only thing my Mom complained about was the mask was very uncomfortable and rubbed a sore on her nose because she was very agitated and kept trying to remove the mask. It might work for your Mom.
Sherri she has been doing cpap testing four hours at a time she is up to twice a day with that. I will ask about the bipap tomorrow when I go back today is day four on the vent and they say it takes time with many ups and downs she is able to tolerate the cpap well but I think they want the volume of her breaths to get more significant from what I am understanding from them. Tomorrow is a new day and tonight I will continue to pray. This is extremely hard especially when they take her off the sedation to do the testing and I can see the fear on her face she knows she has a tube I'm sure.
my dad is having heart bypass surgery and is 79 - they say the surgery wont be a problem it will be from his lung condition from copd - he is a very active 79 yr old works like an ox - any one out there ever went thru this ? I am scared and so is he
I an also an RT. Twice daily CPAP will be extended to longer trials. At 5 days out of surgery she still needs pain meds which can mess with her breathing. Give a little more time. No the tracheostomy may not be in that long and will actually accellerate her weaning. Plus there is an advantage for her to speak and swallow train with rehab. The bipap issue will probably be shot down by the doctor. The mask causes skin breakdown which punishes the hospital by fines. Plus it is a lot more work for the staff. Mom may not be able to receive pain meds for reasons of keeping her breathing. Plus if she needs to be re intubated for failure she just doubles her risk for pneumonia which can lead to another fine to the hospital. 

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