Thank you for your response.
The patient, who is my wife, was admitted to intensive care unit (ICU) five months back after she became unresponsive in the general ward of the hospital, where she had been admitted the previous day for gastroesophageal reflux disease (GERD) and elevated blood pressure (BP). Computed tomography (CT) scan showed generalized cerebral edema and some infarction. The edema has been treated with diuretics. When initial weaning failed about eight days post ICU admission, a chest X-ray was done, which showed left lung collapse with pleural effusion in both lungs. Bilateral chest tubes were inserted in addition to antibiotic treatment. A tracheostomy was also done while she commenced daily physiotherapy. X-ray taken two weeks ago showed resolution of the lung, which has fully expanded. Chest tubes have been removed and there is good air movement on auscultation. But, the patient is having challenges going off the ventilator. She has been on CPAP mode for nearly two weeks with intermittent attempts of weaning. Daily chest physiotherapy has been continued and she is on antibiotics. Tracheostomy is also frequently suctioned. She however cannot stay off for more than 30 minutes. There is agitation, sweating, the elevation of BP to over 200/120 mmHg, and partial loss of consciousness. It seems there is a buildup of carbon dioxide (CO2) causing necrosis. Diaphragm and intercostal muscles seem to have suffered disuse atrophy. I am seeking help and alternate opinions on a guided approach to successfully weaning her off the ventilator. The intensivist here has put in quite some effort, but I feel we can do with some external help and guidance, hence I have come here. We are young couples. I am 30 years old and she is 28 now. We have two daughters, the last delivered just a week before she was admitted to hospital.