A patient with amyotrophic lateral sclerosis has a tracheostomy tube in place. He has been unable to perform an SBT successfully and has been receiving mechanical ventilation for 4 months

An appropriate recommendation for this patient might be which of the following?
1. Transfer to a long-term care facility
2. Evaluation for the use of noninvasive ventilation (NIV)
3. Termination of ventilation
4. Waiting until the primary cause of respiratory failure has been resolved
a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 3 only
d. 1, 2, and 4 only

ANS: A
Unless evidence of irreversible disease exists, a patient who requires prolonged ventilatory sup-port should not be considered permanently ventilator dependent until 3 months have passed and all weaning attempts during that time have failed. Those failing to wean may require placement in a long-term care facility.