Background
On October 4, 2016, a 47-year-old morbidly obese female was transferred to an Alabama Level 1 Trauma Center from an outside hospital with cellulitis to her left lower extremity. Prior to her emergent transfer the patient had become acutely hypoxic and required intubation with maximal ventilator settings. Upon arrive she was febrile with an oral temperature of 102.3 with Acute Respiratory Failure along with the following co-morbidities:
- Left Lower Extremity Cellulitis
- Bilateral Opacities/ ARDS
- Sepsis
- Non-oliguric Acute Kidney Injury
- HTN
- Morbid Obesity
- Elevated Troponins
- Possible Pulmonary HTN
- Possible combined systolic and diastolic CHF
The patient was admitted to the MICU orally intubated and ventilated on ACVC settings with 100% FIO2 and on Nitric Oxide. She was continuously agitated and unable to wean off sedation, therefore a tracheostomy was placed on October 13, 2016, to help ease weaning from ventilator and sedation. During her hospital course the patient was placed on intermittent hemodialysis due to acute tubular necrosis from sepsis, rhabdomyolysis and hypoxia. The patient was considered a complicated ventilator wean and the Special Care Unit was consulted.
Special Care Unit
Clinical information was reviewed by the Special Care Unit Team and the patient was accepted for aggressive ventilator weaning on October 19, 2016. She was on the following ventilator settings:
- Mode: ACVC
- Ventilator Rate: 16
- FIO2: 75%
- Tidal Volume: 360
- PEEP: 8
The patient received quality high touch nursing care along with comprehensive treatment modalities from Respiratory Therapy, Physical Therapy, Occupational Therapy, and Speech and Language Pathology and was successfully weaned from ventilator November 1, 2016, and de-cannulated on November 11, 2016. She was discharged home with Home Health Care and the support from her family on November 12, 2016. Upon discharge the patient was able to perform bed mobility, transfers and ambulate 20 feet with a rolling walker and supervision. The SCU team has maintained communication with her and she is currently thriving at home.
