On October 27, 2016, a very active 65-year-old male who suffered a witnessed cardiac arrest while swimming at the YMCA was transferred to a Level I Trauma Center in Alabama from an outside hospital for ECMO consideration. He was positive for Enterobacter and Pseudomonas before transfer as well as the following co-morbidities:
- Acute Hypoxemia Respiratory Failure
- Lactic Acidosis
- S/P Cardiac Arrest
The patient was admitted to CICU orally intubated and ventilated on ACPC settings. He was sedated on propofol and had a Fentanyl PCA. During his initial hospital course, three (3) Bronchoscopies were performed with findings of scattered sanguineous secretions. Extubation was attempted on November 3, 2016, however failed and required re-intubation. Tracheostomy performed November 4, 2016, due to prolonged ventilator support. Nutrition was provided by enteral feeds through nasal Dobhoff Feeding Tube. Patient had history of Anxiety and failed multiple PSV trials due to tachypnea. At this time the CICU team felt that the patient would benefit most by transferring to the Special Care Unit for comprehensive ventilator weaning.
Special Care Unit
Clinical information was reviewed by the Special Care Unit Team and the patient was accepted for aggressive ventilator weaning on November 7, 2016. He was on the following ventilator settings:
- Mode: ACPC
- Ventilator Rate: 6
- FIO2: 40%
- PEEP: 6
On November 12, 2016, after 7 days in SCU the patient was successfully weaned from the ventilator. With quality high touch nursing care coupled with comprehensive multi-disciplinary treatment modalities from Respiratory Therapy, Physical Therapy, Occupational Therapy and Speech and Language Pathology, the patient progressed well enough to discharge to Acute Inpatient Rehabilitation on November 17, 2016. Prior to discharge from the Special Care Unit the patient was tolerating a speaking valve and a regular diet with thin liquids. At discharge the patient was capped, on room air, speaking clearly and tolerating well.
Post Discharge follow up showed patient was successfully decannulated during his first few days at the Inpatient Rehabilitation Unit.