Azhar Nawaz, Inamul Haq, Muhammad Rashid, Khalid Mehmood Tariq.
Chronic ventilatory support in a critically ill patient.
Pak Armed Forces Med J Jan ;56(2):198-200.

A 62 years old lady suffering from hypertension and supraventricular tachycardia for the last thirty years, suddenly developed weakness in limbs, her talk became irrelevant and incoherent and was unable to stand, she was brought to the hospital, and a supportive treatment was started. After 6-7 hours, her power in limbs was restored to a larger extent but her breathing was still laborious. After about a week`s stay at the hospital she was discharged with almost complete recovery. On 24th July 2001 she again had the similar problem at her home, and after about 12 hours she went in to respiratory arrest. She was resuscitated and brought to the PAF Hospital Sargodha, where she was placed on the ventilator. Initially controlled mechanical ventilation(CMV) mode was used and after 6-7 hours when she started making some respiratory effort was switched over to synchronize intermittent mandatory ventilation (SIMV) mode. She was shifted to Sheikh Zayed Hospital Lahore. Over there she was thoroughly investigated, a part from other investigations MRI of brain and cervical spine was carried out, which revealed only senile atrophic changes. EMG and Nerve conduction studies were carried out, which were normal but the patient, had no respiratory effort. Tracheotomy was performed and her respiration was supported with SIMV mode. After about 20-25 days weaning off the ventilator with T-piece was attempted but was unsuccessful. Several attempts were made to extubate her but all failed. Since then and till today she is daily put on ventilator at night for about 5-6 hours, to make her sleep comfortable, because she cannot sleep with out the ventilatory support. Nutritional support is not a problem in our patient as she is fully conscious, cooperative, and can take food orally. She is maintaining a constant weight of 58 Kg despite of a prolonged ventilatory support. During the last 31/2 years on ventilatory support whenever she develops respiratory tract infection the interval of respiratory support is Increase.

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