Comprehensive Rehabilitation in Patient Care during Ventilator weaning process

CPTE-Chest Th 25th June 2015 13:00-13:45

Bangkok Rehabilitation Center Team

นพ.พิพัฒน์ ชุมเกษียร

Care and Share Topic

• Healthcare Global Streams 2015

• Why Comprehensive Rehabilitation and Team ?

• The Patient we care, need Person-Centered care

• Ventilator weaning care : Pathway or Journey (work shop) • Quality and Safety : monitoring and precaution

Comprehensive Rehabilitation in Patient Care during Ventilator weaning process

CPTE-Chest by Bangkok Rehabilitation Center Team

Quality and Safety In Healthcare, London 2015

Comprehensive Rehabilitation in Patient Care during Ventilator weaning process

CPTE-Chest by Bangkok Rehabilitation Center Team

Why Comprehensive Rehabilitation ? Co-Creating Team, Transdisciplinary Team Team= Healthcare staff+ Patient&Family Identify Person-need, What matter to you? Participatory Goal setting Program management

Healthcare staffs Attending physician Intensivist, Medicine ,Surgeon Consulting physician Anesthesist, Nutritionist, Pulmonologist , Cardiologist, Nephrologist, Neurologist, CVT, .. , Psychiatrist Physical Medicine and Rehabilitation Paramedic : Nurse, Pharmacist, Dietitian, Physiotherapist, Occupational Therapist

Patient and Family : who we care? • Respiratory insufficiency/failure - Pneumonia, Asthma, COPD, Atelectasis, Bronchiectasis,.. - Intrinsic lung disease: Pulmonary fibrosis, CA lung - Traumatic Chest contusion, Fracture ribs, Pneumo-Hemothorax - Post surgery : Thoracotomy, Sternotomy, InterCostal Drainage,.. - Spinal defect: Scoliosis, Ankylosing Spondylitis,.. • Cardiac failure, Myocardial infarction • Stroke, Seizure, TBI, SCI, Neuropathy , GBS, Myopathy • Kidney failure • Liver failure • Critical illness Multi-Organ Failure

Comprehensive Rehabilitation in Patient Care during Ventilator weaning process

Care and Share Topic

• Healthcare Global Streams 2015

• Why Comprehensive Rehabilitation and Team ?

• The Patient we care, need Person-Centered care

• Ventilator weaning care : Pathway or Journey(work shop) • Quality and Safety : monitoring and precaution

Person’s need-Centered Care

Comprehensive Rehabilitation in Patient Care during Ventilator weaning process

CPTE-Chest by Bangkok Rehabilitation Center Team

Problem list Person need

Care and Share Topic

• Healthcare Global Streams 2015

• Why Comprehensive Rehabilitation and Team ?

• The Patient we care, need Person-Centered care

• Ventilator weaning care : Pathway or Journey(work shop)

• Quality and Safety : monitoring and precaution

Comprehensive Rehabilitation in Patient Care during Ventilator weaning process

CPTE-Chest by Bangkok Rehabilitation Center Team

Ventilator weaning care : Pathway or Journey(work shop)

Clinical Assessment + Diagnosis ( PathoPhysiological Diagnosis) Problem list Patient needs Participatory Goal Setting with Patient and Family Program management as a Jouney

CPTE-Chest by Bangkok Rehabilitation Center Team

Ventilator weaning care : Pathway or Journey(work shop)

Clinical Assessment + Diagnosis ( PathoPhysiological Diagnosis) Day 1 1.Aspiration pneumonia RLL , RLL atelectasis with Respiratory failure, on CMV mode Sputum culture : Staph Aureous,+ve MRSA 2.Acute Stroke:Right Hemiplegia, Left MCA infarction, Aphasia, Dysphagia 3.Paroxysmal AF with Rapid VR 4.DM 5.Smoker 1pack/day

Problem list : Ineffective cough,Atelectasis RLL,Aspiration,..

Patient needs: go home

Participatory Goal Setting with Patient and Family: independent ADL and ambulation, attend his son wedding next month

Program management: ( Dynamic synergy to clinical conditions) PT chest + Fluimucil Nebulizer ( BID), Vibration, Head tilt 30*

RLL segmental expansion, cough assisted machine, gentle suction PT neuro (Daily) : Neurofacilitation and progressive upright activities OT(Daily) swallowing test and safety swallowing training Monitor: Gastric residual content< 50ml., SaO2>95%, AF with VR 60-100/min. SBP 120-160 torr., Neurological change

CPTE-Chest by Bangkok Rehabilitation Center Team

Ventilator weaning care : Pathway or Journey(work shop)

Clinical Assessment + Diagnosis ( PathoPhysiological Diagnosis) Day3 1.Aspiration pneumonia RLL , RLL atelectasis with Respiratory failure, on SIMV mode Sputum culture : Staph Aureous,+ve MRSA 2.Acute Stroke:Right Hemiplegia, Left MCA infarction, Aphasia, Dysphagia 3.Paroxysmal AF with Rapid VR 4.DM 5.Smoker 1pack/day

Problem list : Ineffective cough,Atelectasis RLL, aspiration water

Patient needs: go home

Participatory Goal Setting with Patient and Family: independent ADL and ambulation, attend his son wedding next month

Program management: ( Dynamic synergy to clinical conditions) PT chest + Fluimucil Nebulizer ( BID), Vibration, Head tilt 30*

RLL segmental expansion, cough assisted machine technique, gentle suction PT neuro (BID) : Neurofacilitation and progressive upright and Transfer activities OT(Daily) swallowing training with food texture titration Monitor: Gastric residual content< 50ml., SaO2>95%, AF with VR 60-100/min. SBP 120-160 torr., Neurological change