Tracheostomy weaning

[smeiyappan]

Hello,

My father had a massive brain hemorrhage four months ago due to hypertension.  Surgery was performed on his left brain to remove the massive hematoma. A trach tube was inserted to help him breath.  My father weaned off the ventilator in about three weeks after the surgery and he was shifted to a room from the ICU.  It has been almost been 2 and a half months since this move and our Doctor now thinks he is finally ready to be weaned off the trach since his lungs are clear and there is no infection that is being treated.

He has a cuffed 6.4 mm  fenestrated trach. When we close the trach tube he makes some vocal noises, but no words.

The doctor's recommendation has been to close the trach (deflated cuff) for 4 hours and leave it open (inflated cuff) for 2 hours and to repeat this twice during the day.  Nights he has the trach open with a T shape thermovent capping the tube.

My father receives dioline nebulizer once in three hours, 3% Normal Saline nebulizer every 6th hour and Flohale 0.5 once in 12 hours.

In the four hours closing time, he receives one of the nebulisers, depending on the time of the day.  He is pretty much breathing on his own most of the time when closed. Although I think his throat dries up a lot in those four hours.  When there is secreation, we remove the cap and remove the secreation which is causing breathing difficulty and replace the cap.   He maintains saturation at around 92 %- 97 %.


My questions -

1. During this trach weaning process is it alright to remove the cap intermittently as required to take care of the secreations?

2.  What is the best way to wean a patient off trach in my father's condition?

3. Any precautions and pointers to keep in mind?

We are at a leading hospital in India, some of the tests and equipments might differ.

Thank you for reading patiently.  A response would be much appreciated.

Thanks again!

Happy New Year.

[Lynn1980]

hi, how was he now? how old was your father then because I also have same experience with my dad.

[smeiyappan]

Thanks! I think he is already using Shiley's

Regards!

[OHNS2010]

Hi,

In this condition it is wise to keep the tube in situ if u want you can try getting Shiley's tracheostomy tube, this is very soft and easy to clean. But it is not available in India, if you have any friends abroad you can get it from them or else you can order it through online also.

Regards
OHNS2010

[smeiyappan]

Thank you for your response.

No, he does not generally get food / water in to the trach tube.  It happened only once and I suspect thats because the nurse had his position wrong while feeding.

No, he is unable to cough out respiratory secretions.  He coughs, but it doesn't get to his mouth, comes out of his trach tube.

I am beginning to suspect he is not conscious enough to swallow and spit out saliva and secreations,

Let me watch him for couple of more days for further questions.

[OHNS2010]

Hi,

I need to know few things:

1. Does he get the food or water through the tube when he consumes them?
2. Is he able to cough out the respiratory secretions?

If the answer to the first question is yes, then you need to continue using cuffed tracheostomy tube. If the answer to the second question is no, then he should definitely continue using the tracheostomy tube. And, if you are concerned about his voice there are couple of tubes which can help in ventilation as well speaking. I can tell you exactly if you can answer to my above questions. While weaning of tracheostomy tube one has to consider lot of factors which can be beneficial rather detrimental to the patient.

Regards
OHNS2010

[hava]

He is doing well. Let him do this pranayam, for speedier recovery.Extra oxygen will go into the lungs, and the left and right brain and he will feel good and relaxed. Also get Divya Medhavati tablets, to help the brain. Keep a check on oxygen level, after he does the anulom vilom. Please let me know how he feels after 28 days.
Build up your timing gradually.If you feel tired or dizzy, stop and resume after one minute.
Anulom Vilom pranayam –
Close your right nostril with thumb and deep breath-in through left nostril  
then – close left nostril with two fingers and breath-out through right nostril  
then -keeping the left nostril closed  deep breath-in through right nostril
then - close your right nostril with thumb and breath-out through left nostril.
This is one cycle of anulom vilom.
Repeat this cycle for 15 to 30  minutes twice a day.
Children under 15 years – do 5 to 10 minutes twice a day.
You can do this before breakfast/lunch/dinner or before bedtime or in bed.Remember to take deep long breaths into the lungs.You can do this while sitting on floor or chair or lying in bed.
January 2nd, 2011