According to the TMZ article posted above, BB is not "keeping her alive." She's breathing on her own.
K_Z, how do they know she's breathing on her own? Would they have withdrawn the vent to see her response? And why does the trach have to stay if she's not vent dependant?
To answer your last question first, anyone who is unresponsive, unable to swallow, cough, and has no gag reflex,
cannot protect their airway. (These reflexes are HIGHER responses in the brain, than brainstem initiation of breaths.) If someone cannot protect their airway, they are at severe risk for aspiration of gastric contents (especially sugar rich tube feed solution), as well as inability to protect their airway from their own secretions. Aspiration kills people-- even alert vent-dependent patients, or patients more healthy than BK. Either by a form of chemical-burn pneumonia, or by bacterial growth from sugar-rich tube feed in the lungs, or infection from secretions. Aspiration is bad, very bad. It leads to permanent lung damage if the person survives the aspiration event. (And aspiration can be a chronic process in the critically ill, leaking bad gunk into the lungs continuously.)
The question then becomes "why" can't they protect their airway, and how permanent is the "why"-- is it the result of medication, surgery and recovery, trauma and recovery, brain damage, etc.
In someone with neurological damage so severe that their level of consciousness and protective reflexes are
permanently altered, the trach is absolutely necessary to protect their airway for the rest of their life.
Pulmonary acute care physiology is considerably more complex than that, but I think that covers the basics.
Now, backing up to, "is she breathing?"
We don't know, because the facility will not tell (due to patient privacy), and the family is not coherent in their messages to the public. I will re-iterate that no one who has been on a ventilator for 3 months, just "starts" breathing effectively again suddenly, with adequate effort and volume, and pressures. Intercostal muscles, diaphragm, and other muscles of breathing are
severely weakened by the process of mechanical ventilation (even after just a few days or weeks), and are scaveneged (thinned and weakened by starvation and catabolic processes).
The brainstem has tissue responsible for the process of initiating, and maintaining respiratory effort. It IS possible for someone to permanently have no higher cerebral brain functions (consciousness, thinking, etc) AND still have some primitive brain stem functions intact.
For someone who has no higher cerebral function, but has some level of brainstem function intact, pulmonary function is tenuous. Often the person may initiate a negative pressure inspiration (try to take a breath-- which the ventilator will recognize) from time to time, or even regularly, but the muscles are too weak to draw in enough air. In that situation, the vent can be set to synchronize a push of air when triggered by the inspiratory efforts of the patient, while also delivering mandatory breaths if the patient doesn't initiate a breath. There are also settings that provide pressure support in between breaths-- holding fragile airways open with positive pressure (similar to CPAP or BiPap, if you are familiar with those machines for home use). There are also settings to provide extra "push" of air/ O2 at the end of breaths (mechanical or organic) to hold open airways. ("Positive end expiratory pressure.") And ventilators are set to deliver a certain volume of air, with a certain blend of oxygen and air, under a certain amount of pressure, with a certain amount of humidity, etc. Ventilation of the critically ill is a very precise area of expertise, with the need to constantly adjust the various settings of blend of gasses and vent settings.
So, the reason I explain all this is that my feeling is that there is a difference of perspective between CH and BB as to what constitutes "life support"-- which is a layperson term, not a medical term. BK almost certainly has the "hoses" from the ventilator attached 24/7 to her trach (if only for humidity)--- but what the ventilator is DOING from moment to moment, hour to hour, is subject to the report of the family member.
If, for example, BK is assisting the vent in any way, it's possible some family members may interpret that as "off life support." If the vent and tubing is attached to her trach, other family members may interpret that as "still on life support." Add to the confusion of the family that apparently BK's seizure-suppression meds have been partially or totally withdrawn. Some may see that as "off life support".
What seems certain is that she is largely unresponsive, has a devastating anoxic neurological injury that is permanent, and has been critically ill for 3 months. There is little to no hope for improvement in that scenario-- as I posted the adult near-drowning outcome statistics many threads ago. Almost no one in similar circumstances has an outcome
even this good-- this is the best that can be expected, after an unwitnessed near drowning, of unknown duration or cause, with prolonged cardiac arrest. It really doesn't get any better than what she currently has, statistically. Sadly.
