Managing Chronic Obstructive Pulmonary Disease After Tracheostomy

Chronic Obstructive Pulmonary Disease - Issues After Tracheostomy

Hello, Dr.
Hong.
My father has a history of chronic obstructive pulmonary disease (COPD) and severe pulmonary fibrosis.
A few years ago, he required intubation due to respiratory failure, but he successfully underwent respiratory therapy and was extubated.
However, this time it is more severe, requiring emergency intubation.
The CT scan indicates that his lungs are completely fibrotic, and after more than three weeks, he could not be extubated and had to undergo a tracheostomy.
After the tracheostomy, he still experiences significant anxiety during respiratory therapy, making it difficult for him to maintain breathing for more than 1-2 hours.
He is currently in a respiratory care center, but the doctors have informed us that we cannot take him home because he still experiences fluctuating oxygen saturation levels due to anxiety while on the ventilator.
Are we really left with no choice but to keep my father in the respiratory care center indefinitely? Do the doctors have any other recommendations? Thank you very much.

Lin Xiansheng, 30~39 year old female. Ask Date: 2022/05/28

Dr. Hong Yuanbin reply Internal Medicine

Based on your description, your father has chronic obstructive pulmonary disease (COPD) along with severe pulmonary fibrosis.
The chances of him being weaned off the ventilator are indeed very low.
Additionally, the fact that he can only maintain respiratory training for 1-2 hours in the hospital indicates that the likelihood of being off the ventilator is quite minimal.
Most patients in similar conditions typically remain in respiratory care centers for life.
A few proactive families may choose to rent ventilators, pulse oximeters, and other equipment to use at home.
In such cases, the patient would be on a ventilator at home, but it can be very challenging for the family to provide care.
You may want to consider all these factors.
Thank you for your question.

Reply Date: 2022/05/28

More Info

Managing Chronic Obstructive Pulmonary Disease (COPD) after a tracheostomy can be a complex and challenging process, especially in cases where the underlying lung condition is severe, as in your father's situation. Chronic Obstructive Pulmonary Disease is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities, often caused by significant exposure to noxious particles or gases, such as cigarette smoke. In your father's case, the additional complication of pulmonary fibrosis exacerbates the situation, making management even more critical.

After a tracheostomy, patients often require specialized care, particularly if they are on mechanical ventilation. The tracheostomy allows for a more stable airway and can facilitate better secretion management, but it does not resolve the underlying lung disease. The fact that your father has been unable to wean off the ventilator for more than three weeks indicates that his respiratory function is severely compromised.
In terms of management, there are several key considerations:
1. Respiratory Therapy: Continuous respiratory therapy is essential. This may include chest physiotherapy to help clear secretions, as well as the use of bronchodilators and corticosteroids to help manage airway inflammation and improve airflow. Regular assessments by a respiratory therapist can help optimize his care.

2. Oxygen Therapy: Monitoring and managing oxygen levels is crucial. If your father's oxygen saturation fluctuates, it may be necessary to adjust the oxygen delivery system or consider non-invasive ventilation options, depending on his comfort and clinical status.

3. Anxiety Management: Anxiety can significantly impact respiratory function, especially in patients with chronic lung disease. Techniques such as relaxation exercises, breathing retraining, and possibly the use of anxiolytic medications may help your father manage his anxiety during respiratory therapy sessions.

4. Nutritional Support: Malnutrition can be a concern in patients with chronic lung disease, as the body requires more energy to breathe. Ensuring that your father receives adequate nutrition can help support his overall health and respiratory function.

5. Palliative Care: Given the severity of your father's condition, it may be beneficial to involve a palliative care team. They can help address not only the physical aspects of his illness but also provide support for emotional and psychological needs for both your father and your family.

6. Family Involvement: It’s important to maintain open communication with the healthcare team. Understanding your father's condition, prognosis, and the goals of care can help you make informed decisions. Family involvement in care, even in a respiratory care center, can provide emotional support for your father.

7. Long-term Considerations: If your father is unable to be weaned off the ventilator and requires long-term respiratory support, discussions about his quality of life and preferences for care are essential. This may involve considering advanced directives or discussions about transitioning to hospice care if appropriate.

Ultimately, while it may seem that your father needs to remain in a respiratory care center, ongoing evaluations and discussions with his healthcare team are crucial. They can provide insights into potential improvements in his condition and whether home care might be a feasible option in the future. Each case is unique, and the healthcare team can help tailor a plan that respects your father's wishes and medical needs.

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