Provincial Prolonged Ventilation Weaning Centre of Excellence (PWC) at MGH

This program is for Intensive Care Unit (ICU) patients who may be able to come off the mechanical ventilator breathing machine but no longer need ICU-level care.  For example, these patients no longer need ICU-level nursing care, frequent suctioning or strong medications that increase blood pressure (vasopressors).

• The PWC is an 8-bed unit located on the T9 respirology ward at MGH
• It is staffed by Respirologists and Nurse Practitioners who specialize in lungs and helping people wean from ventilators.
• The PWC is officially recognized by the Ontario Ministry of Health as a Provincial Weaning Centre of Excellence.

Admission Criteria

• Adult ICU patients who remain on a mechanical ventilator breathing machine for more than 14 days and have a tracheostomy in place (patients can be referred earlier than 14 days if a prolonged wean is anticipated).
• Patients who are in stable condition, apart from mechanical ventilation 
• Patients who no longer need ICU-level nursing care
• Patients who can activate a call bell. 
• PWC accepts patients who are on dialysis kidney replacement treatment
• Patients who do not have a clearly irreversible disease, such as metastatic cancer or advanced dementia 

Care in the PWC unit

• When a patient moves to the PWC, our team meets with the patient and family.
• Together, we make a care plan that fits the patient’s needs and goals for recovery.

Recovery Process

In the PWC, we help patients:

• Use the breathing machine less and less
• Get stronger and move more (sitting, standing, walking)
• Communicate better with special tools and speech help
• Take the right medicines safely
• Support emotional and mental health
• Build strength with good nutrition

Family Participation

• Families are an important part of the care team.
• We encourage family members to be involved and help support the care plan that matches the patient’s wishes and goals.

Medical Updates

• Families will get regular updates from the PWC Nurse Practitioner 
• If there are major changes to the patient’s condition or treatment, a doctor will call to explain.
• To make sure communication is clear, we ask families to name one primary contact person (spokesperson).
• If no one is named, we will contact the Power of Attorney (POA) or Substitute Decision Maker (SDM).

Family Meetings

• Family meetings can be arranged upon request.
• These meetings include updates from the doctor and a chance for the patient, family, and healthcare team to talk about progress, treatment plans, and goals of care.

Transitioning from the PWC unit

• When a patient improves, they may move to:
  • A medical or rehabilitation unit
  • A rehab hospital
  • Their first original hospital
  • Their home with home care support
• Some patients may still need the breathing machine part of the time.  They may move to:
  • Their first original hospital
  • Their home with home care support
  • A rehabilitation centre or chronic care unit
  • A long-term ventilation centre

Non-Invasive Ventilation Program (NIVP) at MGH

Overview

• This program helps patients who need non-invasive ventilation (NIV) (commonly known as CPAP or BiPAP machines) to breathe, either during the day, night, or both.
• Patients can come from regular hospital wards, step-down units, or Intensive Care Units (ICU) as long as they don’t need ICU-level care. For example, these patients no longer need ICU-level nursing care, frequent suctioning or strong medications that increase blood pressure (vasopressors).
• This program helps patients wean off of their non-invasive ventilator or helps them to go home safely with their non-invasive ventilator.
• Patients in this program may stay in one of the 8 beds in our Provincial Prolonged Ventilation Weaning Centre of Excellence (PWC) at Michael Garron Hospital.

Who this Program Helps

Who this Program Helps

This program supports patients with:

• Chronic breathing problems (long-term respiratory failure)
• High carbon dioxide levels (CO₂) in the blood
• Low oxygen levels (O₂) in the blood
• Neuromuscular diseases (such as ALS or muscular dystrophy)
• Spinal cord injuries
• Obesity hypoventilation syndrome or sleep apnea
• Restrictive lung disease
• Chronic obstructive pulmonary disease (COPD) needing long-term NIV

Our Goals 

Each patient is assessed by our PWC care team

• Care is guided by Respirologists who are experts in non-invasive ventilation (NIV)
• Our team works with the Ontario Ventilator Equipment Pool and private home ventilation vendors to help patients get the right equipment for home use
• Support patients to return home safely and live well in their community
• Improve quality of life and make breathing easier
• Use our hospital’s experience to help other hospitals care for complex patients

MGH WEANING PROGRAMS’ RECOVERY TEAM

• Our multidisciplinary care teams provide complete care for patients in all of our ventilation and weaning programs including:
  • Long Stay Program (LSP)
  • Provincial Prolonged Weaning Centre of Excellence (PWC)
  • Non-Invasive Ventilation Program (NIVP)
• Each patient receives care from a team of skilled professionals who work together to support recovery and independence.

Meet the Care Team

• 👩‍⚕️ ICU Physicians (Intensivists)
  • Lead care for patients in the LSP and guide all medical decisions.
• 🩺 Clinical Utilization Coordinator
  • Coordinates the care team and creates a personalized care plan for each patient in the LSP.

     • 🫁 Respirologists

• Lung specialists who oversee care for patients in the PWC and help with ventilator weaning.
• 👩‍⚕️ PWC Nurse Practitioner
  • Coordinates care for patients in the PWC, ensuring the plan fits their recovery needs.
• 👨‍⚕️ Long-Term Ventilation (LTV) Ward Doctors
   o Attending doctors who oversee the care of patients admitted to the LTV floor
• .🎓 Clinical Educators
  • Train and support nurses to provide excellent and up-to-date patient care.
• 💙 Critical Care Registered Nurses
  • Provide 24-hour bedside care for patients in the LSP.
• 💙 Registered Nurses and Registered Practical Nurses
  • Provide 24-hour care for patients in the PWC.
• 🌬️ Respiratory Therapists
  • Help patients breathe comfortably, manage oxygen and ventilator settings, and guide weaning.
• 💊 Pharmacists
  • Review medications and ensure they are used safely and effectively.
• 🥗 Registered Dietitian
  • Assesses nutrition needs and creates meal plans to help patients regain strength.
• 🗣️ Speech-Language Pathologist
  • Helps patients with swallowing and communication during recovery.
• 💪 Physiotherapist, Occupational Therapist, and Therapy Assistant
  • Help patients move, exercise, and regain independence with daily activities.
• 💬 Social Worker and Transition Navigator
  • Supports patients and families with emotional well-being and practical needs (like discharge planning).
• 🧠 Psychiatrist
  • Provides emotional and mental health care, helping manage stress, trauma, or mood changes.
• ⚖️ Bioethicist
  • Helps with complex care decisions and provides compassionate, trauma-informed support.

Feedback from our patients

“The team in MGH’s Long Stay Critical Care Program went above and beyond. It’s a very collaborative team. Many different healthcare professionals worked together to help me in my recovery. I felt everyone genuinely cared about my well-being and were invested in my health. Thank you to everyone on the team!”

– Michelle Garth, previous participant in MGH’s LSP

“Recovering from a critical illness in the Intensive Care Unit (ICU) requires a team of health professionals working in concert. The LSP Team at MGH did just that and the result was Eileen’s recovery in a much shorter period and to a level we could only dream of achieving. This multidisciplinary team was able to provide higher levels of care in areas such as physiotherapy, pharmacy and respiratory care. The patient benefits from this approach are huge – they can leave hospital sooner and healthier. We believe that, in the ICU, an approach such as this should be the future.”

– Eileen Young, previous participant in MGH’s LSP and PWC, and her husband, Dr. James Young