Weaning from a ventilator and speaking with a ventilator on

[EllenLRoss]

Our father is 82.  He was very active and independent before he suffered a TBI a year ago.  A trach was installed and he was put on full vent support for three months, then he was on partial vent support for 5 months.  During this period, his oxygen saturation was in mid to high 90’s. At the end of February, 2011, he was off the ventilator completely for more than two weeks,   breathing with just his open trach to room air without any type of HMEs (Heat and Moisture Exchange devises).  Then his oxygen saturation started going down two weeks after being off vent to lower 90’s and eventually to low 80’s.  His doctor suspected that lack of humidity of inspiration air caused mucus plugging and put him back on partial ventilation support.  According to his doctor, the ventilator is the best way to keep his airway warm and humidified.  Currently, he is off vent for about 4-6 hrs every day and oxygen saturation is mostly at mid to upper 90’s.  All of his pulmonary tests show normal results and no infection. His doctor doesn’t allow him to be completely off vent due to the earlier episode.  We are seeking advice on what can help him to be completely off the vent, whether he needs to wear a HME device at all times in order to wean him from ventilator, and what type of HME would be suitable for him. We did research and found a HME device called TRACOE ®HUMID ASSIST I, manufactured by Boston Medical, which provides a highly effective respiratory air filtering function for patients with a tracheostoma.  We are looking for someone with knowledge of this device that can advise us whether this HME is suitable for our father or if there are better alternatives.

Our father has tried to speak simple phases a few times, but due to the trach, we could only see his lips move and were not sure what he tried to express.  His doctor suggested deflating the cuff attached to the trach tub. This was not successful since the deflating of the cuff caused non-stop coughing.  We did research on devices that can help trach patients with or without a ventilator to speak.  Two of the devices caught our attention; 1) MONTGOMERY VENTRACH Speaking Valve (by Boston Medical), designed to offer ventilator-dependent, tracheostomized patients the opportunity to speak during inspiration and expiration without interruption; and 2) TRACOE phon assist I SPEAKING VALVE (by Boston Medical), designed to fit the 15mm connector of any trach tube, which is adjustable, allowing either speech or free inspiration and expiration when speaking is not required.  We are looking for advice on whether these speaking valves are suitable for our father and whether there may be better alternatives.

[hava]

Is it possible to breathe normally through the nose, without any tubes, for 2 minutes?

[Chakravarthy Mazumdar, MBBS]

Hi, Thanks for the query. I am not aware of such device. This requires a Critical Care Expert to analyze as many such things are tracked by our eyeballs. So I think you should meet one in person can describe the problem along with device. Do not the sales people come for demonstration. This forum cannot help in such queries which are real time mechanics except for a person who does home visits.