Patients who are dependent on the ventilator for breathing are slowly weaned off their reliance by specialised machines. ST PHOTO: GIN TAY
The Straits Times (27 March 2024)
Early rehabilitation enables their overall hospital stay to be cut by average of 81 days
Shipyard engineer Jaime Mendoza, 57, suffered a stroke in September 2020.
The stroke affected his brain and his ability to breathe, so he was given a tracheostomy, where a tube is inserted into his windpipe to allow air into his lungs. He was kept in the intensive care unit (ICU) for about a month before he was moved to the general ward.
The family had been out celebrating his daughter’s birthday when he suddenly felt unwell and was hurried by taxi to the emergency department of Tan Tock Seng Hospital (TTSH).
"He was in (the) hospital for the next three months. He came home for a month before being hospitalised at Ang Mo Kio Rehabilitation Centre from March to May 2021," his wife, Mrs Edna Mendoza, 57, told The Straits Times.
His seven-month stay, first at TTSH and then at the rehabilitation centre, would have been cut by close to three months – or an average of 81 days for such patients – if he had been taken directly from the ICU to the Ventilatory Rehabilitation Unit (VRU).
Patients with conditions and injuries that affect breathing, such as head injury, stroke, lung diseases, heart attack, pneumonia and spinal cord injuries, would do better when they are moved directly from the ICU to a specialised rehabilitation unit once their underlying conditions are stable, said Dr Lui Wen Li, a consultant with the department of rehabilitation medicine at TTSH.
"In 2019, the average stay in hospital for patients needing ventilators to breathe was more than 200 days. We realised that rehabilitation is not the main focus of acute (care) hospitals," she said. "They cater more to managing acute medical and surgical issues rather than specialised rehabilitation. Often, patients are not able to work towards improvement in speech, mobility and swallowing."
In 2020, the rehabilitation medicine team started a pilot programme at Ang Mo Kio Rehabilitation Centre to provide specialised, intensive and advanced service to wean patients off their reliance on ventilators early and restore them to health. It worked on two ventilator- assisted patients with complex rehabilitation issues at a time.
Mr Jaime Mendoza’s family took him to the Bird Paradise at Mandai and are looking forward to a short trip to the Philippines later in the year. PHOTO: EDNA MENDOZA
The programme led to the setting up of the VRU, and it came with specialised equipment and a dedicated team. When the unit moved to TTSH Integrated Care Hub in September 2023, the number of patients who could be taken care of grew to five.
Since the pilot project in 2020, 23 patients have been admitted to the VRU.
Dr Lui listed the results of their VRU care:
- More than nine in 10 patients spent time out of bed within the first day of admission and all were standing up or even moving around, with assistance, within the first week, compared with less than half doing so before the unit existed.
- More than nine in 10 patients had their ventilation hours significantly reduced, compared with previously, when most were weaned off the ventilator and had the tracheostomy tube removed only after discharge from hospital.
- Caregiver training started as early as the first week that the patient was in the VRU, unlike previously, when caregivers were trained only after acute medical or surgical issues had been settled.
- All the patients had a mode of communication established and could speak while on the ventilator.
One patient who benefited from going into the VRU early is retiree Lau San Heng, 71. He fell off his motorcycle in August 2023 and suffered injuries to his head and chest. He required a tracheostomy tube and was dependent on a ventilator.
His daughter Vivian Lau, 50, said he was admitted to the ICU at TTSH and remained unconscious even after surgery.
"His doctor told us to be prepared that my father would have to rely on machines for a long time to help him breathe," she said.
"We were also prepared initially that we might have to place him in a nursing home that could take care of his ETT (endotracheal tube)."
Ms Lau learnt that there was only one step-down care institution that could manage such patients and there was a long queue for the beds there.
Fortunately, Mr Lau went through a month of intensive rehabilitation at the VRU, including mobilisation, swallowing and speech therapy, and was able to reduce his need for ventilation support.
He eventually managed to breathe on his own and no longer needed the tracheostomy tube. His family was relieved that he could return home without the need for a ventilator.
As for Mr Mendoza, he joined the VRU for his rehabilitation when he was admitted to Ang Mo Kio Rehabilitation Centre in March 2021, and with help from both the unit’s team and the home care team, he is slowly regaining strength.
"At the latest check-up last month, the doctor said he can travel, but only for short distances on the plane," Mrs Mendoza said.
"We wanted to take things slow, so we had a family outing to Bird Paradise. If things continue to go well, perhaps we will take a trip to the Philippines at the end of this year."