This 77 year old male was admitted with multiple systems involvement including COPD, CAD, renal disease, and hyperglycemia. He had failed numerous attempts to wean from mechanical ventilation using conventional methods in the short-term acute hospital. He was emaciated in appearance and was receiving his entire daily nutritional intake via a G-tube. His physical condition was too impaired to meet accepted criteria for the ventilator weaning.

While this patient was in our facility, he was seen by the rehabilitation department, dietary, nursing and respiratory care. A coordinated approach was initiated with all disciplines involved to facilitate weaning from mechanical ventilation. A intensive regimen of nursing care, nutritional support, and respiratory, physical and occupational therapies was put in place, with a rigid schedule of activity. Initially this patient required maximum assistance with all care. He could not feed himself independently, and the extent of his physical strength was to sit on the edge of the bed with two caregivers in attendance.

Over a period of four months, his strength gradually increased until he was able to walk 100 feet with 25% assistance of one person at his side. He was able to take at least fifty percent of his daily nutrition by mouth, and was able to bathe and toilet himself. During this time he was weaned completely off the ventilator, and was subsequently discharged home with the tracheotomy tube decannulated.