Weaning is the process of reducing the ventilator support which may be done quickly or over days to weeks. It is more complex and harder for the patient if they have been on the ventilator for a long time. This process of weaning requires effort from the patient with help from the healthcare team which includes physiotherapists, dieticians, doctors, and nurses. Relatives can be a great source of comfort for the patient during this time and can be at the bedside to encourage the patient. All activities require some energy and muscle strength. The physiotherapists draw up a program of exercises which they do with the patient and nurses. Relatives may also help. Warren Nursing & Rehab is proud to have a successful ventilator weaning program coordinated by our Pulmonologist with the 24/7 onsite oversight of our Registered Therapists and Nurses.

Under the direction of a Pulmonary Medicine Physician, ventilator patients receive skilled services provided by Respiratory Therapists, Highly Trained Nurses, and Certified Nursing Assistants. Additional services include but are not limited to Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Licensed Social Workers, and many more. Warren firmly believes in the interdisciplinary team approach to provide the best outcome for each individual resident in our care. Together, they offer an individualized approach to ensure our resident’s best quality of life.

Our ventilator program is designed to treat a wide variety of ventilator-dependent or temporarily dependent residents. Our unique array of skillset, technology, and abilities allow us to have expertise across the board.

• Ventilator Dependency
• Post-Operative Respiratory Conditions
• Airway Management
• Pulmonary Infections
• Reactive Airway Disease
• Hypoxia
• Chronic Obstructive Pulmonary Disease (COPD)
• Respiratory failure
• Emphysema
• Asthma
• Pulmonary Infections
• Pneumonia Treatments

• Nephrologist
• Pulmonologist
• Nurse practitioners
• Respiratory Therapist
• Dietitians
• Physical Therapist and certified assistants
• Occupational Therapists and certified assistants
• Speech-Language Pathologists
• Nursing assistants
• Licensed Social Worker
• Working with outside Hospice Teams Collaborating together

Are Tracheostomy and Tracheotomy the same thing?

Yes, it is, simply different names for the same thing.

What is a tracheostomy tube?

A tracheostomy tube is a short, soft, flexible plastic tube that is placed into the windpipe through the stoma. A stoma is a medical term for the surgically placed hole. The tracheostomy tube is smaller in diameter than the inside of your, loved one’s windpipe. This reduced the distance from the oxygen to the lungs and aids in oxygenation. The trach tube keeps the windpipe open so your loved one can breathe easily. When the trach tube is in place, you will not be able to hear your loved one talk because the air travels out the stoma instead of through the vocal cords (where sound is made) and out the mouth. The amount of sound made is affected by the amount of air your loved one, can breathe around the trach tube.

What is the anatomy of the trachea in relation to the esophagus? 

The trachea and esophagus share a common wall in the throat.  The back wall of the trachea is the front wall of the esophagus.

The following problems may need a tracheostomy to keep the airway open and help their breathing:

• Narrowing or scarring of the windpipe or breathing tubes
• The inability of the vocal cords to move normally
• An abnormality such as softening or collapse of the windpipe or bronchial tubes
• A need for a ventilator to assist breathing
• A disease that affects muscles that control breathing
• A disease that affects nerves that control breathing

Is it normal for a patient to feel soreness in his/her neck around the tracheostomy tube area?

That is normal and expected after a recent tracheostomy tube change and will lessen gradually over time.

What is a speaking valve?

A speaking valve is a special device used by a patient with a tracheostomy. It is placed on the end of the tracheostomy tube or in line with the ventilator circuit. The patient breathes in through the speaking valve and trach tube. Then the patient breathes out through the vocal cords, mouth, and nose. This allows the individual to use their voice and improves the sense of smell, as well as swallowing functioning.

How do you know your loved one is ready for a speaking valve?

Every person is different, but your loved one must meet the following criteria:

• Medically stable with no urgent concerns being addressed by the doctors
• The ear, nose, and throat doctor along with their pulmonary doctor must confirm that they have an open airway above the level of their trach tube.
• No thick secretions that could get in the way of breathing or plug their trach tube or the Passy-Muir speaking valve.
• Alert with readiness to communicate and/or taste food for pleasure, with the supervision of our team.

How do you use a speaking valve?

The Passy-Muir speaking valve helps your loved one talk with a clearer voice. Your loved one breathes in through the speaking valve and tracheostomy tube and then breathes out through the mouth.

Why can we not use the Passy Muir valve with the cuff inflated?

The reason why the valve must not be used with the cuff inflated is that the speaking valve is a one-way airflow mechanism. The patient inhales air through the speaking valve but exhales it around the tracheostomy tube and then through the nose or the mouth. If the cuff is inflated with a speaking valve, the person will only be able to inhale air and will not be exhaled since there will not be any room around the tracheostomy.

Is a tracheostomy temporary or is it permanent?

It can be temporary or permanent.  Basically, the tracheostomy is placed for a breathing problem.  If the problem is resolved, then the tracheostomy can be removed.  However, if the problem does not resolve, then it may potentially be permanent.

Whenever the patient is tolerating weaning from the mechanical ventilator. We can downsize the tube as a step toward decannulation of the trach from the resident.

Can an individual still swallow with a tracheostomy tube?

This varies by person. A person’s ability to swallow is likely to be impacted following a tracheotomy due to the involvement with the structures used for swallowing, in addition to reduced senses of smell and taste. Furthermore, as stated previously, the back wall of the trachea is the front wall of the esophagus, the tube that food travels through.

Any difficulty swallowing is called dysphasia. Dysphagia can lead to aspiration. Aspiration is when food, drink or saliva passes the level of the vocal cords which leads to the lungs. Everyone experiences occasional aspiration (when something goes down the wrong way or gets stuck). However, this becomes a great concern when the difficulty persists and can lead to serious complications, such as aspiration pneumonia.

How can I tell if a loved one has dysphagia or is aspirating?

There are a variety of signs and symptoms that can help determine the presence and type of swallowing disorder. The following are appropriate questions to discuss.

• Do you cough or choke while eating/drinking?
• Do you clear your throat frequently while eating/drinking?
• Do you have problems swallowing pills?
• Are some foods easier to swallow? Are some foods more difficult to swallow?
• Do you get a runny nose during or after eating/drinking?
• Do you get watery eyes during or after eating/drinking?

What do I do if I feel like a loved one may have dysphagia?

Contact your physician or ENT who will likely refer your loved one to be assessed by a speech-language pathologist (SLP). If your loved one does have dysphagia, he/she can work with an SLP in restorative or compensatory therapy to rehabilitate oral and throat functioning and/or determine the safest level of oral intake.