April 5, 2017 • Female, 59
Patient is a 59-year-old white female initially admitted to hospital on December 12, 2013. Her medical history included complications from sarcoidosis and a recent hospitalization for hypercapnia. She was evaluated by the lung transplant team and a bilateral lung transplant was performed on January 10, 2014.
Patient’s hospital stay was complicated by sepsis, subglottic stenosis, acute blood loss anemia, multiple fractures, respiratory failure, depression, pulmonary hypertension, PTE, deconditioning and a new ESRD diagnosis. She remained hospitalized, with two LTAC discharges and subsequent readmissions to STAC, since her December 31, 2013, admission. Her last readmission to STAC was on November 23, 2016, to the lung transplant service.
Patient was deemed as one of the most difficult to attempt vent weaning. The Special Care Unit was consulted. On April 5, 2017, nearly 3½ years after admission, the patient was admitted to the Special Care Unit for vent weaning with a goal of trach capping during the day and Trilogy/ventilator at night. This goal would have allowed her to possibly qualify for an outpatient dialysis chair. She was admitted to SCU on the following vent setting:
Ventilator Rate: 20
Inspiratory Pressure: 15
Special Care Unit
She was admitted to Special Care Unit on April 26, 2017, with the agreement that this would be the last attempt at ventilator weaning. If unsuccessful the transplant team would resume primary care for this patient. On April 31st, 2017, the patient was successfully weaned from the vent. She was able to tolerate trach collar with 40% oxygen during the day and pressure support ventilation at night to her trach. Trials for trach capping with nasal cannula oxygen during the day and BiPAP per face mask at night were started on June 2, 2017. The patient was able to be decannulated on June 20, 2017.
On June 27, 2017, with comprehensive treatment from Nursing, Physical Therapy, Occupational Therapy, Speech and Language Pathology and Respiratory Therapy she was discharged to Inpatient Rehab. The patient took her first steps in four years while in the SCU. Shorlty after her transfer to inpatient rehabilitation, she was successfully discharged home.