Provincial Prolonged-Ventilation Weaning Centre: For Patients and Families

Who can be referred?

The PWC accepts referrals from any Intensive Care Unit (ICU) in Ontario.

Who meets admission criteria for transfer to the Prolonged-Ventilation Weaning Centre?

Adult ICU patients who remain on a mechanical ventilator for more than 14 days Patients who can participate in and direct their own care

Patients who are in stable condition, apart from their need for a breathing machine Patients who have a documented plan in place about how they wish to be cared for (i.e. advance care plan and goals of care)

 

For patients who do not immediately meet the admission criteria, referral can result in an Ontario Telemedicine Network teleconsultation between the PWC care team and the referring ICU team.

• Patients who have a feeding support in place
• Patients who do not require kidney replacement treatment (dialysis) – PWC is  awaiting approval to provide this service
• Patients who do not have a clearly irreversible disease such as metastatic cancer or advanced dementia

 

What does the weaning process typically look like?

Once accepted into the program, we give patients up to 48 hours before starting the weaning process to allow them to adjust to their new environment. During this time, the interdisciplinary care team completes their initial assessments.

Upon admission, we will arrange an interview with the patient and their family to better understand how to best care for the patient. Future follow –up meetings will be scheduled.

Weaning then proceeds in carefully monitored steps, which involves lessening ventilator support and increasing periods of the patient breathing on their own. Patients receive assistance to achieve as much independence as possible, based on personal and team goals established prior to and during their stay.

The program focuses on rehabilitation, including early mobilization (sitting, standing and walking) and physical therapy on the ventilator.

Communication may be a challenge for many patients as speaking is not possible when receiving breathing support from a machine. Every patient is assessed by a speech therapist and we use a variety of tools to support communication.

We also take measures to reduce the risk of the many complications associated with the prolonged need for a ventilator, including infections, blood clots, bleeding, heart attacks, skin breakdown, and anxiety.

If complete weaning from the ventilator occurs, this may lead to removal of the tracheostomy tube (breathing tube placed in neck), removal of feeding tubes and no further need for intravenous lines.

Sometimes a patient is only partially weaned from the ventilator and may require ongoing support either via the tracheostomy tube or a special mask during the night or part of the day.

Although most patients are discharged back to their referring hospitals, some are discharged to rehabilitation facilities to complete their recovery, such as nursing homes, chronic care institutions, or long-term ventilation centres. A small number of patients are discharged directly home.

As part of our comprehensive patient-focused care, we also provide palliative care for patients and their families in end-of-life situations.

Programs of expertise in Prolonged & Long-Term Ventilation in Ontario

• Amyotrophic Lateral Sclerosis (ALS) Clinic - Sunnybrook Health Sciences Centre
• Canadian Alternatives in Noninvasive Ventilation (CANVent) Ottawa
• London Health Sciences Centre
• Westpark Healthcare Centre

Learning modules and resources

1. Learning modules related to tracheostomy care and caring for an individual requiring long-term ventilation - Offered by Westpark Long Term Ventilation Centre of Excellence
2. Learning modules related to respiratory complications and treatment including non-invasive ventilation for individuals with neuromuscular disease or spinal cord injury - Offered by CANVent (Canadian Alternatives in Noninvasive Ventilation)

MGH’s Provincial Prolonged-Ventilation Weaning Centre for Excellence is mandated by the Ministry of Health and is part of a greater provincial strategy which aims to effectively reduce pressure on ICUs and ensure resources in the community that provide people who require long-term ventilation with more opportunities to receive the right care, in the right place, at the right time.

To learn more about this strategy, please visit the main program page.