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At 14 years old, Marie I. sustained a gunshot wound leading to a complete spinal cord injury (SCI). She was dependent on a ventilator, with little hope for regaining her ability to breathe independently.
After a catastrophic injury or in the midst of a serious illness, ventilators save lives for patients like Marie. However, in addition to exponentially increasing mortality rates, ventilators prevent patients from engaging in rehabilitation quickly and intensively after injury or illness — thus delaying progress and hindering positive outcomes.
As a result, ventilator weaning is often a top priority during rehabilitation care. Increasing overall health, longevity and quality of life depend on weaning patients from ventilators as quickly as possible — and liberating a patient, permanently or for intervals, represents a life-changing outcome.
Ventilator Liberation: A Novel Approach to Vent Weaning
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As one of the few rehabilitation hospitals in the United States to accept patients on ventilatory support, Shirley Ryan 黑料网 set out several years ago to develop a “ventilator liberation” program, a novel approach to ventilator weaning that taps into the hospital’s clinical and research expertise in muscle rehabilitation.
At the time, the standard of care simply was to reduce ventilator support and see how patients performed.
Shirley Ryan 黑料网 researchers and clinicians realized they needed to change the process altogether, and this exploration came at a favorable moment. Colin Franz, MD, PhD, had been honing his skills performing diaphragmatic ultrasounds on patients with respiratory challenges following COVID-19. Ultrasound enabled him to better assess the function of breathing muscles.
With his knowledge, as well as the expertise of other team members — including Natasha Bhatia, MD, and Stephany Kunzweiler, DPT — Shirley Ryan 黑料网 began performing diaphragmatic ultrasounds on every patient with SCI who admitted with ventilator support. Clinicians combined this approach with other methods of examining respiratory muscle function.
The team sought to understand whether using ultrasound to measure how well the diaphragm muscle works could predict whether patients with cervical SCI who rely on ventilators could successfully be weaned. For those patients most likely to succeed in ventilator liberation, clinicians used targeted-muscle training — focused on strengthening all functioning muscles used for breathing and increasing efficiency in the process.
Glimmer of Hope Leads to Liberation
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Given the severity of Marie’s SCI, the Shirley Ryan 黑料网 team knew that no medical professional could optimistically predict that Marie would achieve successful, independent breathing. However, after weeks of focused breathing training — and with the support of the ventilator and multiple diaphragmatic ultrasounds — they saw a glimmer of hope. One side of her diaphragm appeared to be moving ever so slightly.
With this realization, and using targeted-muscle training, clinicians worked to wean Marie off the ventilator during the day — a significant milestone. In the years since, Shirley Ryan 黑料网 clinicians have continued to successfully wean both adult and pediatric patients from ventilators — while also cutting in half the number of days between admission and liberation.
Additionally, the Shirley Ryan 黑料网 team has increased knowledge through research. For instance, in one study, they focused on the thickening ratio, the diaphragm’s ability to thicken during breathing. Researchers found that patients with a thickening ratio of 1.2 or higher on at least one side were almost certain to regain some ventilator independence.
A New Tool for Better Outcomes
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Overall, the diaphragmatic ultrasound has been shown to be a powerful tool in ventilator liberation, leading to increasingly tailored care and enhanced recoveries for patients like Marie. Safe and efficient ventilator weaning doesn’t just lead to increased independence and quality of life. Importantly, it leads to better long-term outcomes, helping patients get back to what they love.
