Weaning From Prolonged Mechanical Ventilator Support
Radius Specialty Hospital-Boston represents the new frontier in the Long-term Acute Care (LTAC) rehabilitation environment previously forged by the Jewish Memorial Hospital and Rehabilitation center (JMHRC). JMHRC provided 75 years of continuous service and expertise in treating medically complex adult patients. Optimizing patient independence in daily activities and social functions with the primary goal of a successful return to the community is the major focus of this hospital. To this end physicians specializing in Pulmonary & Critical Care Medicine, General Internal Medicine and Rehabilitation Medicine along with registered nurses, speech therapists, occupational therapists, physical therapists, individuals specializing in prosthetic and orthotic devices, dietitians and social workers all function within the framework of a multidisciplinary team to offer structured programs for:
- Individualized assessment and medical treatment to enable recovery from a variety of acute injuries.
- Progressive rehabilitation and emotional support for patients requiring long term mechanical ventilation. Ventilator weaning is accomplished through a progressive approach individualized to each patient’s needs.
- Specialized exercise equipment designed to increase mobility in a safe and medically supervised environment.
- Recreation therapy to use leisure time in a manner that enhanced productivity and contributed to patient well-being.
- Comprehensive management on an individual basis to optimize hospital length of stay and planning for discharge and follow-up care.
The unit has an ability to care for as many as 35 patients requiring pulmonary physician-directed weaning from the long-term mechanical ventilation. The majority of referrals originate from the major medical centers within Boston and hospitals from the surrounding suburbs, but the Radius Unit has also cared for patients from Maine, New Hampshire, Connecticut, New York and Washington. Radius Specialty Hospital-Boston includes a 40-bed satellite site within the Quincy Medical Center in Quincy, Massachusetts. As the burden of pulmonary disease continues to increase world-wide, rehabilitation of the pulmonary disease patient will form the centerpiece of this modern LTAC hospital. The ventilator and Pulmonary care unit at Radius Specialty Hospital-Boston and Quincy provide a comprehensive program for:
- Aggressive treatment of patients who have been previously unable to wean from mechanical ventilation provided by a two experienced and dedicated Pulmonary & Critical Care Specialists from Boston Medical Center who will implement and supervise all aspects of the weaning process throughout the hospitalization. This is not a “just another rotation.”
- Invasive Ventilatory Care is available using all modes of mechanical ventilatory support including Assist/Control, SIMV, CPAP and Pressure Support Ventilation
- Non-Invasive Ventilatory Care is also available including nasal or face-mask CPAP and BiPAP, full oxygen delivery system with monitoring, and overnight oximetry.
- On-site arterial blood gas analysis.
- On site Radiology services for routine roentgenograms of the chest, abdomen and extremities and full CAT scanning and MRI services at Quincy Medical Center.
- Full Laboratory Services off-site at The Carney Hospital, Dorchester, MA and Quincy Medical Center.
- A dedicated Wound Care Team organized by a Board-certified Physiatrist.
- Full Medicine and Surgical Consultation Services
- A dedicated Patient Advocacy Service
- On-site Pharmacy services including a computer based system to track medication orders, dosages, patient allergies, and drug interactions together with a computerized automated dispensing unit on each patient care site.
- Therapeutic Services include:
- Speech therapy to facilitate patient communication as functionally as possible and assess swallowing function. This is a central focus on the ventilator care units with use of in-line Passy-Muir valves to enable speech.
- Occupational therapy to optimize daily activities impaired from physical, cognitive, sensory, motor, and/or psychological dysfunction.
- Physical therapy to restore, maintain, and promote overall physical functioning for patients with injury or disease processes involving the neuromuscular, musculoskeletal, cardiopulmonary, or central and peripheral nervous systems.
- Therapeutic recreation to facilitate patient participation in life-directed goals despite physical, mental, or emotional illnesses or disabilities
- Initial assessment of all patients requiring long-term mechanical ventilation and defining an individualized weaning program
- Daily rounds to assess weaning progress and adequacy of mechanical ventilatory support modalities
- Daily assessment for optimal oxygenation to balance demands with needs.
- Daily assessment for dyspnea which can impair ventilator weaning
- Daily assessment of integrate ventilator weaning plans with physical therapy interventions
- Interactions with Speech Therapy to determine safety and duration of in-line Passy-Muir valves to enable speech and to assess safety of swallowing mechanisms to permit oral nutrition.
- Review of overall medical goals with the General Internal Medicine physician to optimize organ recovery and minimize adverse drug interactions.
- Assessment and replacement of tracheostomy tubes if dysfunctional or if a previously determined time limit on usage has expired.
- Review of all chest roentgenograms in the hospital on ventilator patients, patients on the consultation service and provide assistance to general medical staff with interpretation as needed.
- Provide Pulmonary Consultation Services to patients on other services at the hospital.
- Quarterly monitoring of the prevalence of ventilator-associated pneumonia and weekly assessment of a VAP prevention strategy including: elevating head of bed to 30 degrees, minimizing sedating medications, providing gastric cytoprotection and maintaining DVT prophylaxis until mobility is restored.
Faculty with clinical and/or research specialty in Weaning From Prolonged Mechanical Ventilator Support:
Martin Joyce-Brady, MD
Christine Campbell-Reardon, MD
Carol Sulis, MD
Allan J. Walkey, MD
Alex White, MD
Katherine Hendra, MD
Aran Kadar, MD
To schedule a clinic visit, refer a patient, or speak with one of our physicians, please contact us at:
Radius Specialty Hospital – Boston
59 Townsend Street
Boston, MA 02119