Does any of this make sense to thoes experienced with this?

[Dano]

On June 15th my Mom went into the Hospital for an illness that appeared to be flu/weakness. She had never been on oxygen before, but did smoke for many years.

Dr's diagnosed her with pneumonia --- from there things went down hill.  Two weeks after diag, she still had a temp and was placed on a ventilator. One week later a trach was performed. 30 days later she was sent to rehab to wean off the vent.

At rehab it seems that she lost every every bit of energy that she had, and her temp began to rise again. The Dr. put her on Vancomyacin. Immediately she began to improve. She went from mandatory breathing to breathing on her own with small amt's of pressure support. After antibiotics ended her temp started again and the Dr. sent her back to the hospital for fluid building around the lungs. As of now she is back in the Hospital with a chest tube draining. All fluid drained showed no sign of infection.  I dont' understand where these infections are coming from? She does have a central line, chest tube, and feeding tube that was just put back in. What a roller coaster ride of frustration. Is there anyone with ideas of what is going on?

[National Jewish]

Empyema is a build up of pus in a body cavity.  It is called pyothorax when the pus is in the pleural space, the area between the lungs and the chest.  The pyothorax can happen when the germ that caused your mom’s pneumonia passed from the lung into the pleural space.  The antibiotic cleared the pneumonia and kept the infection from spreading beyond the pleural space.  The pyothorax flared when the antibiotic was stopped.  Generally the pyothorax needs to be drained as well as being treated with the antibiotic.

It is possible that the antibiotic was strong enough to keep the germs from growing in the laboratory, but not strong enough to keep them from growing in your mom’s chest.  So it may appear that there is no sign of infection from the fluid that is draining.  It may be helpful to repeat the culture of the fluid that is draining to see if any germs will grow now.  It would be important that the fluid be cultured for all possible germs, especially anaerobic germs.  Anaerobic germs grow well without oxygen.

Generally the chest tube is left in place until the infection is completely controlled.  It will be important to make every effort to get your mom out of bed as early as possible.  Also your mom’s nutrition will need to be watched closely.

[RTFLY]

I agree that it is a roller coaster ride. I am actually involved with ventilator weaning and rehab so I hope I can help you understand a little about what happens. After your mom went to the hospital and was put on a ventilator, that was obviously very serious. It is good to hear the physicians placed a tracheostomy tube as promptly as they did. Having a trach isn't very appealing but it makes it much easier for the patient to be weaned. Weaning can be a long process. Some patients wean quickly, others take a while. The center I work for is actually one of the most successful weaning centers in the country, which is something we take great pride in. Your mother has a few sources for infection. One is the trach. The others are the central line and the feeding tube(I'm assuming the chest tube was inserted at the hospital when she went back there). All these can be routes for infection to enter the body. Having a trach exposes individuals to infections like pneumonia on a more frequent basis and frequent pneumonias can be a cause of pleural effusions(fluid around the lungs). We deal with that from time to time and have to send patients back to an acute care hospital(where I also work/teach)so they can be taken care of on a more acute level. Once her infection is under control and the pleural effusion is cleared up then hopefully she can be sent back to rehab to begin her weaning again. It sounds as if she was doing well with her weaning before she became ill again(spontaneous rate with small amounts of pressure support). Again, it is a roller coaster and things can and may take longer than you expect. Try and be patient and speak with her doctors and caregivers about her progression. Also, be positive and play a role in her care. Patients seem to do better with strong family interaction. It sounds as if your mother was very ill and has had quite a course. It is not uncommon for patients to experience some depression as well when being so ill and confined for so long. As I mentioned, be positive with your mother and reassure her that she will get better. I wish you all the best...keep us posted!
                                   J.C.I. RRT RCP

[MacyMaid]

What a wonderful response.  Yes, it is so very important for family interaction when a love one is ill.

Depression does come into play and knowing family is there for you...makes the road easier.

[april in CA]

please HELP! this is very long - but i'm a very concerned daughter who is a wreck and my mom lives on the east coast and i on the west: my mother had a massive heart attack on 12/3/02 - my father performed cpr and then 911 arrived they did electric shock to mom she was rushed to a hospital and she was in a coma for 2 days woke up feeling great! my sister and i flew to the east coast on 12/4. mom had no short memory but she was "mom" but drs. said this would return. later that eveing she was transferred out of icu to a normal hosp rm - during the course of the next 24 hrs. she had what the drs. called a bad reaction to a medication (lortab)next thing mom was really out of it - they attempted to try a CPAP but this did not work they had to put mom back in icu and she had to be intubated - she was a very difficult intubation this took hours. we finally got to see mom and she looked horrible her eyes and face were swollen - of course she was sedated by this time. over the next few weeks they kept mom somewhat sedated - she did not make too much progress. during this time her kidneys failed we had to do hemo dylasis - luckily her kidneys are funtioning on their own now. over the next few weeks mom needed a pace maker/defib and during the same time the drs wanted to do trachotmy. she was so weak and unstable the drs did not want to do anything invasive to her. she finally had the surgerys 1.5wks ago and in that repect things are going well. they have attempted to wean mom from the vent many-many times over the lst few weeks but she is unable to breath unassisted still. She has been in icu until late yesterday now mom's in something between icu and a regular rm. i know this is good but it's been 36 days! these are my worries questions concerns: how long does it take to wean someone from the vent can it take months?? Because it has been so long without much progress - is it possible she may never be off it? no one is telling us too much... has anyone ever expericend anything like this (mom's 57 yrs old has copd and is on oxygen 24/7 the last 1.5yrs.) she has caths and and has not been out of bed for 35 days and while in icu has not been able to even roll over on her own! i'm so worried about her body - does anyone have any experience with something like this? please reply if you have. thank you.