I feel like I ought to clarify, I give the IS for patients mostly in the inpatient unit in which I'm a nurse. I am a big fan of not losing recruitment in patients that have poor mobility because of really bombed out stamina secondary to hypoxia.
(We also use mechanical lifts to put patients up to the chair if they can't do it themselves and self prone patients who can)
The utility of IS in preventing atelectasis aside, it also allows patients to feel they are able to do something to improve their recovery, which is big when you're going to be in the hospital for months at a time with no visitors.
The other major challenge we face is nutrition, given that patients breathing 40rpm can't really chew much and it seems to mess with their swallowing. Often our doctors will suggest NGT placement and tube feeds if our patients have been consistently consuming less than 50% of their meal tray for multiple days. The real problem there is that it's tricky to place an NGT on someone whose respiratory status is so fragile, and you REALLY want to avoid causing a pneumo.
My colleagues have become very good at NGT placement, and we've been using a bedside NGT with a camera implanted that will allow us to visualize the inside of the stomach and verify that we aren't in the airway.
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