Does anyone have any ideas or tips/tricks to use while attempting to wean patient's who are suffering from severe dementia? How is this done where you work? Are you able to give them medication before weaning? Are you usually successful?
We have seen a rash of severe dementia (A&Ox0-1) patients and cannot wean them from the vent. Usually they progress like this: We wean sedation, attempt to let them breath on their own, they panic, fight, HR and RR jumps sky high and we end up bolusing sedation and turning the vent back.
Eventually we wean them off sedation entirely, keep them restrained, trach them and they end up in a LTAC still on a vent.
I suggest Morphine/Ativan/Xanax/Seroquel/anything at all but they just won't budge. Usually I get a lecture about over sedation and impaired oxygenation for my trouble.
What exactly is the difference between bolusing them back under when they freak out and giving them something to help them relax before we wean? It just doesn't make sense to me. They are still on the vent if they become too sedated we can just turn it back which is what we end up doing anyway!
I have tried sitting and holding the patient's hand, singing to them, leaving soothing music on, encouraging family to come in when we wean, etc. Occasionally one of these measures may prove successful but more often than not nothing works.
I just recently had a pt. like this who still had an active order for Morphine 2mg which I gave and that pt. weaned for 2 hours before they had to turn the vent back. The order was d/c when I came back the next night and he is back to only weaning for a few minutes at a time.