Humidified Trach Collar (HTC)

[je82857]

I emailed you quite some time ago re: my mom being weaned off the ventilator via CPAP.  I appreciate the response I received.  My mom now is on a trach collar, receiving humidified oxygen.  She is on CPAP only at night.  My question is:  Is this a very good sign?  Is the trach collar the last step before her trach being capped?  She is doing very well, she has been off the ventilator during the day (with the HTC) for 4 days now.  I try talking to the respirator therapists at the nursing home she is at, but I don't get very good answers.

I'm taking this as a very good sign that she is well on the way to recovery from the ventilator.  Do you agree?

Thank you.

[Oxygen7]

Sorry to hear about your scare last Friday, it can be a frightening thing when that happens.  Do you personally know how to change your mothers trach tube? If not I think you need to learn and actually change it yourself. If a  has a trach and for some reason is doing bad all of a sudden, you should always change the trach out.  It could have a mucus plug stuck in it or the trach could be out of place.  In answer to your question, honestly, she may never be weaned from the CPAP becasuse of her age or other various reasons. I work with kids and I have had a couple of kids that were on ventilators from the time they were born until about age 4 or 5 and then they were able to be taken off of them. But they are kids.  Hopefully everything will work out with your mother.

[je82857]

We had quite a scare last Friday evening.  My mom was rushed from the nursing home to emergency.  Turns out her trach tube was displaced, and all the scar tissue she has was causing an upper airway blockage.  The nursing home kept trying to put more pressure in (via CPAP) and all the air was going into her stomach.  At emergency they changed her trach tube to a longer one, to get behind the scar tissue, and pumped her stomach.

She is now back at the nursing home, switching between SIMV and CPAP.  Yesterday they tried the collar again, but she only lasted 10 minutes.

I want to thank you for giving me your input.  It is much appreciated during this very difficult time for our family.

In your opinion and from your experience, do patients like my mom ever get weaned?  I would appreciate an honest answer from you - I will keep in mind that it is just your opinion.  Do you have any success stories you can share with me?

Thank you,
Jacky

[Oxygen7]

First of all I don't want you to completely rely on what i'm saying...I'm not a Dr. But the fact that she was a COPD patient previously and on O2 before, it doesn't help now trying to wean her off the CPAP.  Since she does retain Carbon Dioxide that is probably a good reason why she keeps dropping her oxygen saturations.  It could also be in relation to her just getting tired from not having any ventilatory support (e.g. CPAP).  She might have to remain on the CPAP but hopefully she will be able to be off for at least a part of the day. Let me know how she is doing.

[National Jewish]

I agree that this is a very good sign and yes, the trach collar is the last step before being capped.  It is too early to tell if she will still have to be on nasal CPAP at night, either for a while or indefinitely

[je82857]

Well, things didn't go very well.  They had her on the trach collar for 24 hours.  The next morning her oxygen saturation level dropped to 80 and she was just exhausted.  They put her back on CPAP for the remainder of Saturday.  On Sunday morning, they tried her again on the collar.  Within a couple of hours her oxygen saturation level dropped to 73.

What causes the level to drop?  Is it that she is a carbon dioxide retainer because of COPD?  Could it be possible that she is just not ready for weaning, that she needs to build up her lung muscles?  Is there a chance she'll never get weaned?

Her history is as follows: She is 78 years old.  Was on oxygen several times per day at home due to COPD.  She fell and broke her hip in December.  Things went downhill fast from there.  She has been on the vent now for 2 1/2 months.

Thanks for any information you can provide.

[Oxygen7]

I am a respiratory therapist so I might be able to answer some of your questions, but not knowing the person and her history I won't be able to help much.  Having her trach capped just depends on how she is doing while off the CPAP or ventilator, and also how well she can maintain a good airway without depending on the trach.  Eventually if she still needs the CPAP at night but not the trach she might be able to switch to a nasal mask CPAP. I hope this helps some.