Case Study 1

Female. 59 years-old. Bilateral lung transplant.

59-year-old female initially admitted to the hospital for a bilateral lung transplant. Her medical history included complications from sarcoidosis and a recent hospitalization for hypercapnia. 

 

The patient’s hospital stay was complicated by sepsis, subglottic stenosis, acute blood loss anemia, multiple fractures, respiratory failure, depression, pulmonary hypertension, PTE, de-conditioning and a new ESRD diagnosis.

 

She remained hospitalized, with two LTAC discharges and subsequent readmissions to STAC.

Nearly 3½ years after her initial admission, the patient was admitted to the Special Care Unit for vent weaning, with a goal of trach capping during the day and Trilogy/ventilator at night. This goal would help her qualify for an outpatient dialysis chair.

 

She was admitted to SCU on the following vent setting:

  • Mode:  SIMV

  • Ventilator Rate:  20

  • FiO2:  35%

  • Inspiratory Pressure:  15

Special Care Unit

If weaning was unsuccessful, the transplant team agreed to resume primary care for this patient. Only fifteen day later, the patient was successfully weaned from the vent. She was able to tolerate a trach collar with 40% oxygen during the day and pressure support ventilation at night. Trials for trach capping with nasal cannula oxygen during the day and BiPAP per face mask at night were started a few weeks later and the patient was decannulated eight weeks after ventilator liberation.

One week later, with comprehensive treatment from Nursing, Physical Therapy, Occupational Therapy, Speech and Language Pathology and Respiratory Therapy, she was discharged to Inpatient Rehab. The patient took her first steps in four years while under our care. Shortly after her transfer to inpatient rehabilitation, she was successfully discharged home.