An 18-year-old female was admitted from an outside hospital. She was found in her college dorm room incontinent of urine and febrile up to 104. She was sent to hospital for further evaluation of presumed autoimmune demyelinating disease. Her admitting diagnosis included:
- Acute Respiratory Failure
- Urinary Tract Infection
The patient was intubated and mechanically ventilated and was unresponsive. Per Neurology, diagnosis was likely viral encephalitis. She received feedings through a nasogastric tube. She was started on trach collar trials but had significant anxiety. Her parents wanted her to return home to New York for further care, however there were many uncertainties regarding the safety of the patient flying with a ventilator and a trach. They were considering a $20,000 trip by air ambulance for transfer to an LTACH.
Special Care Unit
Fifteen days after initial admission, transfer to Special Care Unit was recommended, clinical review team consulted and she was transferred. At the time of transfer she had been on trach collar at 40% FiO2. She was able to follow commands but had material cognitive deficits and was unable to swallow anything safely.
During her stay in SCU, with multidisciplinary treatment from Physical Therapy, Occupational therapy, Speech and Language Pathology and Respiratory Therapy, the patient was able to make exceptional functional gains. She was decannulated just 6 days after transfer. Her nasogastric feeding tube was discontinued and she was able to eat a regular diet. Cognition improved and she assisted with booking her flight on her laptop computer. She was able to walk a total of 100 feet with seated rest breaks.
After only 17 days in the SCU, the patient was discharged to an Inpatient Rehab facility in New York for further recovery. She was able to safely travel on a commercial flight. The patient continues to make improvements and was able to return to her university for the fall semester.