Question
What are some things we can do to help patients with brain injury decrease their time on the ventilator?
Answer
Let's talk about some early interventions with our brain injury patients. Many patients have respiratory failure, especially more severe and prolonged mechanical ventilation. We may need to do a tracheostomy and then attach mechanical ventilation through the tracheostomy. What are some things that we can do to help these patients? We want to establish communication, whether through gestures, writing, or a speaking valve, and determine their level of cognitive function. We are all working together to assess what this patient can do. Is it reproducible, or is it just spontaneous involuntary reflexive movements? We can initiate some swallowing treatments. That may start with some basic exercises and then move towards the initiation of pill intake. In early intervention, we want to do everything we can to help decrease these patients' time on the ventilator, which is a team effort. We will talk more about what we can do to facilitate that. Speaking valves are a wonderful tool that can be used in-line with tracheostomized patients on a mechanical ventilator. The valve can be attached to the ventilator tubing and allow the patient to communicate, improve their secretion management and improve their cough strength. Using the valve is something that can be done with an interdisciplinary team. We love our respiratory therapists working with these patients and helping them improve these essential functions, decrease their time on the ventilator, and help the individual with their cognitive function. Respiratory therapists using the speaking valve help orient and better assess how their cognitive functions are working. We can reduce that ICU delirium and help them in many ways. A great tool that we have as an interdisciplinary team.
This Ask the Expert is an edited excerpt from the course, Brain Injury Effects on the Respiratory System, presented by Sarah Busser, MA, CCC-SLP, CBIS.