Is there a good chance my grandma will be weaned off the vent and be ok?

Ranae1221 asked...

My grandma is 70 years old, never had lung or heart issues. She fell in December fracturing her ankle. It was bad enough that she required surgery and an external fixator. She went to a SNF for rehab; Grandpa is on Hospice and I can't provide 24/7 care. Prior to the fall, she started having some confusion, more than normal. After the fall, it was horrible. Met with a neurologist who ordered lots of tests. Last week we got an official diagnosis of dementia. He said he could not give a specific type without more testing that would have to be done out of town, 3 hours away. I (her healthcare POA) opted not to seek further testing. They did start Excelon and Namenda. Her usual mental status the last 2 months greatly varied; she would be oriented only to person, then go 24 hours where she slept a deep sleep, then call having forgotten what happened the last 2 months, then be upset we were 'interrupting' her routine if we visited. There was no rhyme or reason and we never knew what the day would bring.

Yesterday I got a call from the SNF that she was having difficulty breathing and was being sent to the ER. Apparently in route, she required to be intubated. Lots of tests later, it was determined she had penumonia (didn't show on chest X-ray but did on CT Scan). She is now in ICU and on a vent. She is easy to rouse; hates when they suction and will thrash about, requiring an extra dose of meds to keep her comfortable.

While I know nothing is for certain, is there a good chance that she will be able to be weaned off the vent and be ok? Especially if she has not had any lung or heart problems before. What should I expect? Last night they did testing to see if her lungs were strong enough to begin weaning, and they weren't. Is there a time frame, like a certain amount of time that if she isn't weaned off the vent she could become dependent on it? Having a diagnosis of dementia, and her usual mental state very disoriented at times, how much does this impact her chances at a complete recovery?

I've dealt with many many hospitalizations for my grandparents, but this is the 1st time a breathing machine has played a part in it.

Expert Answer

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

Sorry to hear that your grandparents are having severe health problems. I am sure it is difficult for you to deal with both of them being ill at the same time.

While it is fortunate that your grandfather is receiving good care with hospice, your grandmother sounds like she is in a health crisis. She is critically ill, as she is intubated and in the ICU. She must have some kind of virulent pneumonia if it caused this type of reaction. While many older persons who develop pneumonia recover well enough to go back home from the hospital, I am not sure about your grandmother. I know that you would like to me to tell you that she is going to be fine, but I cannot. Only time will tell if she is able to be weaned off of the ventilator. I know that the hospital staff will keep working on her to improve her status, especially with antibiotics and the vent. It may take the medications and therapies some time to work, so you will really need to wait and see. There is a time frame for when the doctors would know she would be dependent on the ventilator. Since they are already trying to wean her off of it, they will see how she does. If she was really sick, it may take a few days. However, if she does not improve in a couple of weeks, they may stop trying to wean her off and consider her "vent-dependent".

You bring up a good point in your letter. Even if your grandmother is weaned off the ventilator successfully, she may come out of the hospital worse in body and mind then before she went in. You need to think about this possibility, and how she will be cared for if this happens.

When I think about your situation, I really do think that you will have to make some tough decisions in the next coming weeks. As your grandmother's decisionmaker, please really try to focus on what she would want done for her, especially if she does not improve. My thoughts are with you.