Use of pulmonary rehabilitation strategies to wean a difficult-to-wean patient: case study

The primary purpose of this article is to describe the effectiveness of an interdisciplinary team and innovative interventions by a pulmonary rehabilitation specialist in addressing one patient's failure to wean from mechanical ventilation. This case study shows the importance of considering both physical and psychological factors that may hinder weaning. An interdisciplinary approach was used to address the patient's anxiety, sleep deprivation, lack of appetite, decreased communication, decreased activity, dyspnea, knowledge deficit about dyspnea and weaning, lack of self-confidence, and decreased verbalization. The pulmonary rehabilitation RCP effectively implemented the following strategies: biofeedback by using a flow-volume display, positive reinforcement, teaching about dyspnea and weaning, and use of the modified Borg scale. The patient's family participated in providing some of these interventions. With a concerted effort by all involved, the patient was successfully weaned from mechanical ventilation.