Mom is in ICU with the result of improper dysphagia management. She had trouble breathing because of the secretions and was intubated Tuesday in the ER. Since then the IVU has weaned her twice and extubated; she does fine for about half a day (6 hrs) after
removal before suffering an event that requires reintubation. It is unclear whether it is a sudden onset of thick secretions coming up that she is not strong enough to dislodge on her own or more of a case of inflammation. They do apparently suction her out
but maybe not effectively. So, she goes for 5-8 hours off the vent just fine, with or without oxygen, and then suddenly becomes hypoxic. I would assume steroids for airway inflammation and mucus thinners, as she is used to with her home nebulizer, for secretions.
We do not know if either of these remedies has been tried or when. They seem to just see if she's going to be fine. That's not happening. How can this critical juncture post-extubation be eased? At 92, she is not a high priority and the doc seems to want us
to allow her to suffocate next time. She was alert and participatory, mostly. This last time she may have been too dopey to cough, even, which is always weak. Additional: would a mucus thinner that is not in mist form, such as a heavy-duty "Mucinex," be a
good idea, since the problem seems to be that 1) the mucus is so thick it can't be easily removed through their suction devices, and 2) besides her own dysphagia issues, on top of that she now has "intubation
dysphagia," so she can't either swallow or cough
it up successfully? Or would perhaps a tracheotomy be a short-term solution, because it makes it easier to suction out deep mucus without re-intubation being the only remedy? They do not seem to do any postural adjustments while off the tube, such as put her
on her side so the whole airway isn't impinged upon. I do not know about PT such as percussion, etc. (you'd think there would be some kind of deep vibratory therapy to help dislodge this mucus.) I find it hard to believe that there is no remedy for choking
on your own phlegm What kind of specialist deals with this? In the elderly or even with just stroke patients or, say, veterans with traumatic brain injuries? Are any associated with hospitals around the SF Bay Area or Savramento/Stockton? They want to cease
re-intubation, which would mean death by choking the next time it happens. Mom was on a puréed diet with thickened liquids and did well with that. She fed herself and went on outings, etc. (see pic from 6/26 at aquarium). It was being given thin liquids in
bed by straw and recently reducing the nebulizer treatments to "on demand" that caused this incident, I'm pretty sure.