- Who can be referred?
The PWC accepts referrals from any Intensive Care Unit (ICU) in Ontario.
- Who meets the admission criteria for transfer to the Provincial 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)
- 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
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.
- 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.
Provincial Prolonged-Ventilation Weaning Centres in Ontario