In this section we answer your clinical or your general questions if your loved one is critically ill in Intensive Care.
Questions we answer relate from answering questions about your loved ones
condition, treatment, prognosis, equipment used, how to manage personalities and dynamics or we also answer any other question or dilemma you might face in your situation!
It is a platform where you can also learn from other people’s challenges in similar situation than yours!
Just send your questions to [email protected] or fill in our “contact us” form and send us your question there.
How long can a breathing tube or endotracheal tube stay in?
A very common question that I get asked quite frequently from family members or friends of critically ill Patients in Intensive Care is how long a breathing tube or an endotracheal tube can stay in when their loved one is mechanically ventilated in Intensive Care. So lets get right into it.
Now, as a rule of thumb, a Breathing Tube or an endotracheal tube is usually staying in your loved one’s throat or Larynx for up to two weeks at the most, unless there are special and rare circumstances. I’ll come to that later.
The reality is that most critically ill Patients in Intensive Care only require mechanical ventilation with Ventilators(Breathing Machine) with a Breathing Tube or an endotracheal tube for a limited period of time. Most mechanically ventilated Patients in Intensive Care only require ventilation with a breathing tube or an endotracheal tube for a few days at the most. The most common reasons for mechanical ventilation with a breathing tube or an endotracheal tube in Intensive Care is post-surgery, trauma, lung diseases such as Pneumonia, Adult Respiratory Distress Syndrome (ARDS) also known as lung failure, COPD, Acute Severe Asthma and also other admissions such as Pancreatitis, Burns, Heart Attack (Acute Myocardial Infarction) or Cardiac Arrest situations. The list is not exhaustive and I only mentioned the most common scenarios in Intensive Care where mechanical ventilation with a breathing tube or an endotracheal tube is necessary.
But because the question that I get asked quite frequently is how long can a breathing tube or an endotracheal tube stay in your loved one’s throat, the answer is that it can almost stay in indefinitely. That’s certainly not a desired goal and again and normally doesn’t happen. Normally I would say that up to two weeks is the longest that I have seen it.
Usually what happens if your critically ill loved one is requiring ongoing mechanical ventilation and it is foreseeable that Extubation or removal of the breathing tube is not on the horizon due to the critical illness of your loved one, normally a formation of a Tracheostomy is the next step.
A Tracheostomy is another tube that is permanently or temporarily inserted into your loved one’s neck into the windpipe going directly into the lungs. This Tracheostomy tube is making it a lot easier for your loved one to be
- mechanically ventilated as the tube is no longer in the mouth
- weaned off the ventilator, as ventilation with a Tracheostomy doesn’t require a huge amount of sedation compared to the amount of sedation needed for when your loved one requires the breathing tube through the mouth
- taken off the ventilator intermittently or permanently to find out how well your loved one is breathing without the ventilator
- generally looked after, as a Tracheostomy is much easier for your loved one to tolerate and is also less risky than a breathing tube or an endotracheal tube
Furthermore, a Tracheostomy tube can stay in infinitely and in fact some People have a life long Tracheostomy tube in place and they can live with it independently.
I hope that answers this common question that I get all the time and if you have any further questions, please send your questions to [email protected]
Also, in order to learn quickly how you can take control, have real power and influence decision making while your loved one is critically ill in Intensive Care enter your email below and get your FREE “INSTANT IMPACT” report so that you can learn instantly what you need to do in order to take control of the situation. Furthermore, you’ll also get 4 more FREE reports such as
- “6 questions you need to ask the most senior doctor in Intensive Care”
- “The 7 most FAQ’s whilst your loved one is critically ill in Intensive Care”
- “10 things you didn’t know doctors and nurses are talking about while your loved one is critically ill in Intensive Care”
- “9 Myths of being a critically ill Patient in Intensive Care”
Sincerely, your Friend
Graham, from Portland USA
Dear Patrik, My 54 year old wife has had a bilateral lung transplant 18 months ago and initially she was doing quite well and she had a good quality of life for the first 12 months after the transplant. We were travelling, she was able to exercise regularly and she managed really well, until over the course of the last 3-4 months, when she became quite unwell. She has now been readmitted back to hospital, initially with shortness of breath and also an infection in her lungs. A couple of days after being admitted to Hospital she had to be transferred to Intensive Care as her breathing was getting worse and she couldn’t be managed on the ward. She has now been in Intensive Care for the last three weeks and she is not getting better, if anything she is getting worse. Initially she was ventilated and after a week or so they tried to wean her off the ventilator but she failed and she ended up with a Tracheostomy. So she now has been on the ventilator with the Tracheostomy for about 2 weeks. It’s terrible watching her and she is mouthing that she wants to die. This is extremely upsetting and frustrating not only for her but also for me and our two adult children. Does she mean it or is she just confused by all the drugs she is getting? It appears that she is getting weaker and weaker every day and that she really is losing the will to live. The Intensive Care team is talking about the infection causing the difficulties breathing and they have also mentioned rejection of her donor lungs, despite all the drugs she is on to minimise the rejection. I am not the expert, but I have been shown some of her chest X-rays and even I could see how bad her lungs on the chest x-ray looked. The Intensive Care team is quite positive and wants to continue treating my wife and me and my children are hesitant and we are wondering how much is enough? Do you think she will get better, or do you think we should start thinking about limiting or even ending her suffering? Dear Graham, I’m very sorry to hear about your wife’s and your Family’s ordeal. It sounds like your wife is very sick in the ICU and it looks like she is not in a good position. First of all, unfortunately it is not too uncommon that Patients after an initial successful lung transplant are returning to Intensive Care with their condition deteriorating because of organ rejection and/or infection. Often one goes with the other. This is even more frustrating, especially since your wife has been enjoying a good quality of life initially. It is often the case that Patients with organ rejection and/or chest infection after lung transplant end up back in Intensive Care, only to find that the initial successful lung transplant was not as successful as everybody thought it was. Unfortunately some lung transplant Patients do come back to Intensive Care with organ rejection/ infection and then they end up with a Tracheostomy and a long term stay in Intensive Care. Those Patients often approach their end of life in Intensive Care and in some cases I have seen this to be over many weeks if not many months. I think your question regarding how much is enough is a reasonable question. Keep in mind however that even though the outlook currently might be bleak that you may want to give it a little bit more time, before making such a major decision as if and when to limit your wife’s suffering. Even though your wife is currently very critically ill, she may improve and if she’s getting better, she will probably also find the will to live. It is difficult for me to say whether your wife is serious about wanting to die, however most Patients in Intensive Care, especially when ventilated and sedated for a prolonged period tend not to remember anything about their ICU stay. Having said that it doesn’t mean that your wife isn’t serious about wanting to die and ‘having enough’ about the situation she is in. It is a very difficult situation and there are often no right or wrong answers, as those situations often tend to be grey in nature. If your wife’s condition will be improving, you and your family will be glad that you continued treating her and if she deteriorates further you might feel guilty that you and your family haven’t stopped her treatment in cooperation with the Intensive Care team. Also, think about other situations in your wife’s life where she has been dealing with adversity. How did she do? I think the answer to that question will give you an indication of what to expect and what decisions you should make. As a rule of thumb, stay positive and support your wife as much as you can! My advice is that you should give it a little bit more time and see how things progress and then make a decision from there. Continue evaluating your wife’s response to what she is going through and since you and your family know her best, make a decision from there. All the best! If you want more support and free resources, just sign up for our free membership and get weekly updates and FREE resources such as our “INSTANT IMPACT” report. Sincerely Your Friend Patrik Hutzel
Jayne, Leeds, United Kingdom
My mother had a serious stroke and she ended up in ICU. She sustained serious brain damage and also went into multi organ failure and she required the kidney machine for almost a week as her kidneys stopped working. I am amazed that after 4 weeks now in Intensive Care how well she has recovered. I have the feeling that she won’t be 100% again as she says random things and she doesn’t speak at all at times. I have so many questions. Do you think she will be able to speak again and also get her full memory back? What are the best treatment options? Thank you.
Congratulations for pulling through those 4 weeks in Intensive Care, together with your mother! It’s never easy and it sounds like you have mastered this terrible time well!
Look, Intensive Care is a strange place to be in and the effects of the therapy in Intensive Care in combination with the stroke could very likely make your mother say random things and/or not speak at all. Keep in mind that if your mother has been in multi organ failure that she received numerous drugs, including sedation(I.e. Propofol, Midazolam, Fentanyl or Morphine etc…). Sedation very often minimises activities including clear speech for quite some time after sedation has been stopped. Especially after a fairly long stay in Intensive Care, Patients might be conscious at the end of their stay in ICU and yet they still don’t fully understand their surroundings until many weeks later. Often Patients don’t remember a single thing whilst they’ve been in Intensive Care.
The effects of the drug therapy in Intensive Care can sometimes also mask other functions, including speech. Also, bare in mind your mother has very likely gone through a prolonged period with a disturbed day and night rhythm. Therefore you might have to give it some time to make a proper assessment of what is causing her speech to be impaired. In the meantime, a speech therapist could assess her speech and swallowing function properly, as one often goes with the other, especially after a stroke. Furthermore, a Neurology assessment can further clarify how much damage has been done by the stroke and how much the therapy in Intensive Care may have impacted on her cognitive function. You might also look into what rehabilitation facilities might be specialised on stroke rehabilitation in your area. Be patient and most of all, stay positive.
The human body is strange and it can work miracles and there is a good chance that your mother might fully recover in her own time. That could be weeks, months or years, but the human body has the capacity to recover from setbacks, even from a stroke that required Intensive Care admission.
Furthermore, your mindset is critical. Stay positive and support your mother as much as you can.
If you want more support and free resources, just sign up for our free membership and get weekly updates and FREE resources such as our “INSTANT IMPACT” report.
Hi Patrik, My brother has been in ICU for 13 weeks following septicaemia following open heart surgery. He is 54 years old and had never been hospitalized before. The whole time he has been fed through a NG tube, he has a tracheostomy , being kept on a ventilator overnight, has had 18 surgeries. He was doing quite well but after removal of the trache for a short time (and failure after an hypoxic event) has required re-intubation . He is, understandably depressed, anxious and has almost lost the desire to fight. We are trying to motivate him. Have put together posters with inspirational quotes and family photos with messages of love. Do you have any suggestions of what else we can do. It is heartbreaking to see him so low. We understand why. Would love to hear any suggestions/ideas? Thank you, Marie Melbourne, Australia Hi Marie, thank you for your question. I am very sorry to hear about the ordeal that your brother and your Family are going through. Let’s look at the positives first. Your brother has never been hospitalized and is quite young at the age of 54. The other positive is that he has a supportive family who is looking for options and is seeking out for help and you are encouraging him. Keep doing that as a first step. It’s almost unbelievable that he has had 18 surgeries within 13 weeks. Now, let’s look at the negatives and the things that very likely stand in the way of his recovery. It’s a massive dilemma for every long-term Patient in ICU and their Families to have no or very little Quality of Life, which is leading to depression. The depression often leads to the ventilator dependency and vice versa. It’s a massive challenge and it’s a vicious cycle. On top of that there is the lack of privacy and the lack of dignity in ICU and other people are running the show. You have already touched on what you and your Family need to continue doing, such as motivating and inspiring him and the family photos. Other practical steps would be to look at continuity of care such as – having regular and experienced nursing staff looking after him(some units have a tendency to let their junior staff or agency staff look after their long-term Patients, as the more experienced staff tend to look after more acutely unwell Patients) – making sure he is getting natural daylight such as having visits outside as soon as his condition allows – can he get a quiet room with natural daylight or is he exposed in the middle of a busy unit with no natural daylight? – making sure that the medical staff are on top of things, again some units have the tendency to almost neglect their long-term Patients, because the staff are getting frustrated as well – ask the medical/nursing staff whether your loved one might be better off with antidepressants – no matter how difficult the situation, stay positive, your brother will feel the positive vibes coming from your family – the longer your loved one stays in ICU the higher the risk of him catching an infection, therefore a side room with no exposure to other Patients and therefore bugs might be an advantage as well As far as his Tracheostomy goes, again it’s nothing unusual in Intensive Care to see Patients having failed attempts to wean them off the ventilator and the Tracheostomy for the reasons I mentioned. Depending on where you live, you might also consider external specialized services such as INTENSIVE CARE AT HOME. There are services available in countries such as Germany, USA and Australia(Melbourne) who focus on weaning long-term ventilated Patients in the home as a genuine alternative to a long-term stay in Intensive Care, generally with a focus on Quality of Life for Patients and their Families. You can find more information at http://intensivecareathome.com.au I have also sent you three more reports for you that we tend to send to our Clients if they enquire about similar issues. The reports I attached are – “6 answers to the 6 most frequently asked questions, if your loved one requires ongoing mechanical ventilation with Tracheostomy in INTENSIVE CARE” – “Follow this proven system to avoid the 3 most dangerous mistakes you are making but you are unaware of, if your loved one is a long-term ventilated Patient with Tracheostomy in Intensive Care” – “Follow this proven 5 step process on how to be in control and influential if your loved one is a long-term Patient in Intensive Care or is facing treatment limitations in Intensive Care” I hope that helps and please let me know if you have anymore questions. We have also more reports available such as “The 5 things you need to know if the medical team in Intensive Care wants to limit treatment, wants to withdraw treatment or wants to issue an NFR(not for resuscitation) order for your critically ill loved one in Intensive Care” Sincerely, Your Friend Patrik Hutzel
Sandra, from New York, USA
We have been told that my aunt has gone into severe lung failure. The doctors and nurses have told us that she is not expected to survive. One month maximum. The ICU team has been talking about Intubation. I think Tracheostomy will be easier as it would likely help her to be ventilated? What would you advice?
thanks for your question. Without knowing the full circumstances, people’s most likely and most intuitive response is to paint the worst possible picture. It’s also intuitive to follow the advice of the doctors and nurses in the Intensive Care Unit.
Because you are not an Intensive Care “insider”, you would find it hard to believe that even though your aunty’s situation appears to be difficult, if not hopeless from the outside, to the point where you think that she is going to die soon, you have to think about the perspective of the doctors and the nurses in Intensive Care.
Even though most of the health professionals working in Intensive Care are optimists(otherwise they couldn’t do what they are doing), they also tend to be careful of what they say to families of critically ill people in order to not give you false hope and also to protect their professional reputation. The reality is that even for doctors and nurses who have worked in Intensive Care for many years, it’s difficult to exactly predict the most likely outcome of your aunty’s stay in Intensive Care.
The reality also is that the trajectory of any Patient in Intensive Care is often hard to predict and doctors and nurses in Intensive Care have usually seen a wide variety of cases, with “good” cases turning bad and “bad” cases coming good.
If your aunty’s lungs are failing she might have ARDS and she certainly would need Intubation as a starting point. Depending on the severity of the lung failure, she might require ECMO and she could well require a Tracheostomy. This is hard to say since I don’t know the exact details of your aunty’s history. But these are some of the most likely scenarios.
I think what’s really important for you and your family is that you are not giving up hope! Ask plenty of questions and don’t be afraid to ask such questions that if the Intensive Care team thinks that your aunty is not going to survive, whether that’s based on clinical facts or just based on the negative mindset of the health professionals they are dealing with. It’s critical for you and your family to stay positive! Your aunty can feel you and your family giving positive vibes!
Also, find out and ask whether the Intensive Care Unit has other Patients waiting for admission to Intensive Care and therefore they have a high demand on beds. With the ICU experiencing a high demand on beds, they may put a more negative spin on your aunty’s prognosis and they may not tell you the whole truth of what is really going on behind the scenes.
Furthermore, you might want to also ask if the Intensive Care team is wondering, that if your aunty’s treatment and recovery is prolonged that it may cost too much and that it may stretch the budget in the Intensive Care Unit.
You should also read our FREE “INSTANT IMPACT” report. In the report you get a ton of information of what’s happening in Intensive Care behind the scenes that is impacting on your aunty’s treatment that you are unaware of.
In the “INSTANT IMPACT” Report ’ll teach you immediately how you can take control, have real power and influence decision making, no matter how challenged, frustrated or vulnerable you, your Family and your critically ill loved one in Intensive Care feel.
In my free “instant impact report you will discover
• how to ask the right questions
• how to eliminate fear, frustration, stress, struggle and vulnerability
• 5 “killer” tips& strategies helping you to get on the right path to control, power and influence in your situation
• you’ll get ‘behind the scenes’ insight so that you understand what is really happening
• how to change your thinking and your behaviour that might hold you and your Family back to have more control, more power and more influence whilst your loved one is critically ill in Intensive Care
• how to control your emotions
• how you need to manage doctors and nurses in Intensive Care(it’s not what you think)
• how to speak the secret “Intensive care language” so that doctors and nurses know straight away that you are an ‘insider’ and that you know and understand what is really happening in Intensive Care
• how to deal with critical situations and end of life situations
• how to manage the rest of your family
If you sign up for our FREE “INSTANT IMPACT” report you’ll also get
- “7 answers to the 7 most frequently asked questions, if your loved one is a critically ill Patient in INTENSIVE CARE “
- “9 myths of being a critically ill Patient in Intensive Care”
- “6 questions you need to ask the most senior doctor in Intensive Care if your loved one is critically ill in Intensive Care. You’ll also get one bonus question at the end of the report”
- “10 things doctors and nurses are talking about if your loved one is critically ill in Intensive Care when you and your family are not present at the bedside”
Sincerely, your Friend
Moira, from Brisbane, Australia My 53 year old sister has been admitted to Intensive Care in the last fortnight with a severe stroke and she hasn’t been well at all. She went through several procedures, including ventilation, had CTs of her brain and she had lines inserted. It looks like now she has developed Pneumonia, probably from vomiting earlier in the week. Worst of all she hasn’t been waking up appropriately for a while, despite the doctors trying to get her out of the induced coma. Because she hasn’t been waking up, the question of who is her next of kin has been raised, as somebody needs to sign for consent for treatment and procedures as long as she is unconscious. What makes matters worse is that my Family can’t agree on what might be in her best interest and several people want to be her Next of Kin. My sister has been divorced and has two children from a previous marriage, who want to be her next of kin. Her current partner is living with her, but they are not married and he also claims kinship. My sister’s children say that her partner doesn’t know her well enough to act in her best interest, whereas her partner claims that her children don’t see their mother often enough to be her next of kin. We have spoken to the social worker in the ICU but again there was no resolve of the issue as the children and my sister’s partner could not agree and all they do is argue even in front of the social worker. I have tried to stay out of the argument and if anything, I tried to be a mediator trying to find a solution. It has also come to the point now, where my sister’s children are avoiding her partner and vice versa. It’s a dreadful situation and it doesn’t serve my sister. Can you share any advice of what to do in such a situation as we can’t agree and the situation is likely getting worse and would definitely not be in my sister’s best interest if we can’t agree? Dear Moira, Great question! The situation you have described is quite a common one in Intensive Care that can create massive issues if not resolved quickly. You have clearly identified that the inability to agree on your sister’s next of kin is causing her harm and is not in her best interest. It also sounds like your sister’s partner and her children can’t agree on the right course of action and they can’t agree on what might be in your sister’s best interest. You have also realised that this situation can’t go on and it needs resolve quickly. First of all, realise that if your Family doesn’t come to a conclusion about kinship for your sister, that other people are running the show, meaning the Intensive Care team will make decisions regarding your sister’s treatment with little or no input from your Family. That in and of itself should be enough motivation for your sister’s children and her partner to come together and find a solution to the problem. Also, something that I have seen over the many years in Intensive Care is that Families who are clear in what they want for their critically ill loved one have a much higher degree of control, power and influence during the time their loved one is critically ill in Intensive Care. Those families usually also agree to have one spokesperson during the time of their loved one’s stay in Intensive Care. On the other hand, Families who don’t agree on a spokesperson or a next of kin during this time of crisis, will have a difficult time to manage not only the family dynamics, but also to manage the dynamics in Intensive Care and their level of control, power, bargaining power and their level of influence diminishes in spades. Furthermore, the situation of having a loved one critically ill in Intensive Care is challenging and frustrating altogether and having to deal with difficult family dynamics only adds up to your and your Families frustrating situation. Worst of all it doesn’t serve your sister, who can feel all of those negative vibes around her. Some action steps for you to consider are • Get your Family together and stress the point that you need to find resolve quickly and that it’s not about the partner’s or the children’s egos and about their mother’s/partner’s best interest • Having difficult family dynamics is nothing to be ashamed of, many families have it and you need to put them aside during this difficult period in your sister’s best interest • Stress the fact that you think that not coming to an agreement will only leave your sister even more vulnerable and your Family will have little or no influence in decision making • It also leaves you and your Family vulnerable in an already difficult situation as you are not united in this difficult situation • Talk through the best and the worst case scenario and find out what all parties involved think would be the best course of action(s) • Make clear to your nieces/nephews and to your sister’s partner that you can only have control, power and influence in this challenging situation if you put your family dynamics and family issues aside • It also sounds to me that some Family members might have difficulties facing the reality and the ordeal your sister is going through and they are putting up ‘barriers’ by focusing on other issues • Once they have accepted the reality they are dealing with, it would be easier on agreeing on the right course of action I have also created a FREE report about “5 things families do who are in control, have power and have influence in the situation when their loved one is critically ill in Intensive Care” Send me an email at [email protected] and I’ll email you the report Sincerely, your friend Patrik Hutzel
Damien from Auckland, New Zealand
Monday 20th May 2013
Damien from Auckland, New Zealand
My 73 year old mother has been in Intensive Care for more than 6 weeks now. Initially she was admitted for open heart surgery, which didn’t go as planned as she was bleeding heavily after surgery and she had to go back to theatre to get the bleeding stopped.
Furthermore, in the next few days after surgery she developed an infection on her chest and she therefore had difficulties getting off the ventilator. She then failed a couple of attempts to have the breathing tube taken out, with the result that after the second failed attempt she ended up having a Tracheostomy.
Initially she has been getting better, but within the last few weeks she has been really struggling as she is still having difficulties getting off the ventilator, despite the Intensive Care team initially saying that a Tracheostomy would be a much easier way to wean her off the ventilator.
Unfortunately my mother has been getting increasingly distressed and depressed in the last couple of weeks as she hasn’t been sleeping at night due to the poor Quality of Life in ICU. She also hasn’t managed to stay off the ventilator for long periods of time. Furthermore, she also suffers from the lack of privacy and the lack of dignity in the sterile hospital environment.
My question is, what can we (my siblings and I) do to help her getting better and how can we also make sure she is getting the best possible care?
Thanks for your question. You’re bringing up some very important questions in your email.
You see, with your mother being a long-term ventilated Patient with Tracheostomy in Intensive Care, there are several issues that come with it.
As you have already correctly identified, she has no or little Quality of Life in a sterile clinical environment and she certainly has no or very little privacy and dignity. Furthermore, it sounds like she is really struggling to get off the ventilator and with the issues that you’ve pointed out such as being distressed and depressed, your mother might have a hard time to get off the ventilator and it might be a lengthy and burdensome process.
What I have seen over the years in Intensive Care is that when it comes to long-term ventilation with Tracheostomy, Patients more often than not enter into a vicious cycle and the long-term stay in Intensive Care triggers depression and the depression triggers the ventilator dependency, as I think that half of the battle your mother is fighting is a psychological dependency on the ventilator. Because she already had two failed attempts to be taken off the ventilator, she has experienced the struggles and the hardship that come with the ventilator dependency already and she is probably afraid and worried that she won’t come off the ventilator and get out of Intensive Care.
Another issue that you may not be aware of is that the longer your mother stays in Intensive Care, the longer she may need to get off the ventilator(vicious cycle) and moreover, the risk of catching a hospital acquired infection is increasing as well as there are a lot of bugs floating around in Intensive Care, increasing the risk for your mother that she is catching an infection. The lack of natural daylight, the sleeplessness and the disturbed day and night rhythm are only contributing to make things worse for your mother.
In order to give you some action steps what you can do to improve your mother’s situation I suggest
• Ask whether your mother can be transferred to a room with natural daylight
• Ask whether your mother can have regular and experienced nurses looking after her(often Intensive Care Units tend to have less experienced or junior nurses or even agency nurses looking after long-term Patients and the more experienced and the senior staff are looking after new admissions). Therefore consistency of care with regular and experienced nurses would be a bonus for your mother
• Ask whether your mother can have regular visits outside the ICU to get fresh air and natural daylight. This is something that can be done if the staff want to, so don’t be afraid to ask
• Make sure your mother is getting regular showers or baths, as this usually improves well being
• Also, bring in your mother’s favourite music, favourite pictures, smells that remind her of home etc… basically anything that reminds her of her own home and familiar environment would be a bonus
• Furthermore, ask around in your community and find out whether there are any Intensive Home Care nursing services that are specialised to take long-term ventilated Patients out of Intensive Care back into their own home as a genuine alternative to a long-term stay in Intensive Care. I bet your mother will blossom if she can go home. Whilst this may not be an option in your area you can still check out such services that are available in countries like Australia or Germany
Find more information on http://intensivecareathome.com.au or http://intensiv-kollegen-gesucht.de/
• Learn to ask the right questions to the Intensive Care team and look for things that can be improved, you can discover a ton of free information and what you need to know in our free reports and I have sent you our free report “6 answers to the 6 most frequently asked questions, if your loved one requires ongoing mechanical ventilation with Tracheostomy in INTENSIVE CARE” where you find comprehensive answers to most of the challenges that you and your mother are facing.
If you are reading this and you are in a similar situation and you also want our free report please email [email protected]
Furthermore, what you can also do is read our Free “INSTANT IMPACT” report. In this FREE report you can immediately improve your and your family’s life whilst your loved one is critically ill in Intensive Care.
Get your Free “INSTANT IMPACT” report by entering your email address below or at the sidebar.
In this free report you’ll discover
• how to ask the doctors and the nurses the right questions
• how to eliminate fear, frustration, stress, struggle and vulnerability
• 5 “killer” tips& strategies helping you to get on the right path to control, power and influence in your situation
• you’ll get ‘behind the scenes’ insight so that you understand what is really happening
with our FREE “INSTANT IMPACT” report you’ll also get four other FREE reports that will help you to take control, have real power and influence decision making when your loved one is critically ill in Intensive Care
the four other free reports you’ll get are
• “7 answers to the 7 most frequently asked questions, if your loved one is a critically ill Patient in INTENSIVE CARE “
• “9 myths of being a critically ill Patient in Intensive Care”
• “6 questions you need to ask the most senior doctor in Intensive Care if your loved one is critically ill in Intensive Care. You’ll also get one bonus question at the end of the report”
• “10 things doctors and nurses are talking about if your loved one is critically ill in Intensive Care when you and your family are not present at the bedside”
Sincerely, your friend
Sarah from London, United Kingdom
My 66 year old husband has been admitted to Intensive Care and he is on full life support. He fell off the ladder while repairing our roof of the house and unfortunately he fell straight on to his head. The damage done to his head, and more importantly the damage done to his brain are so severe that me and my 2 daughters have been told by the Intensive Care team that the chances of recovery and the chances of survival are slim and that we should brace for him to die in the next couple of days. Apparently he sustained a really severe bleed into his brain from the fall and the head trauma and the bleed in his brain is causing severe brain damage. Me and my daughters are feeling very distressed about my husband’s accident as it happened out of the blue. My husband and I just retired in the last year and we were looking forward to a better and quieter life with more time for each other and more time for the family. To make matters worse, me and my daughters feel that we are pressured to accept and also to agree that the Intensive care team can “withdraw life support” from my husband so that he can die. We are still so shocked, stressed and overwhelmed by the whole experience that we are not ready to let him go and we want more time with him. We also feel like one senior doctor in particular is not able to empathise with our feelings at all and all he keeps going on about is how sick my husband is and how poor his prognosis is. He just doesn’t seem to care that we want more time with him. We do understand how sick he is and we do understand that he is probably going to die, but we are just not ready as yet and we want peace of mind. Furthermore, my husband’s brother, to whom my husband is very close with, is living overseas and he is currently on a plane to fly in and he does not want his brother to die, without him being there. Can you please give us advice on how to handle the situation so that we can get to spend more time with my husband?
thank you for your questions and I am very sad to hear that your husband is so sick and is a Patient in Intensive Care. To me it sounds like your husband has sustained a really bad and nasty head and brain injury. Brain and head injuries are really bad and the brain is usually the only organ that human medicine is unable to control. All other organs can be controlled at least temporarily in Intensive Care. This is unfortunately not the case with the brain. There is no equipment, technology or other clever invention that can take over the function of the brain. It also sounds to me like you are not questioning the clinical facts, which is a good starting point as it sounds to me like your husband is unfortunately so sick and unwell that he is going to pass away soon after life support has been withdrawn. In order for you and your 2 daughters to take control of the situation and get the outcome you want, which sounds to me like you want more time with your husband before you let him go, which would then give you more peace of mind, you need to address the following. Ask the senior doctor whether he wants to have an empty bed in the Intensive Care Unit for another Patient to be admitted, as it could well be the case that the Intensive Care Unit is very likely experiencing a lot of pressure on their beds and there are more admissions waiting for the currently occupied Intensive Care bed. What is most likely also be the case is that the senior doctor you referred to is doing the maths in his head and he might think that every day the ICU bed is occupied with a Patient that is most likely going to die, is costing around $ 4,000- $ 5,000, coming out of the Intensive Care Unit’s budget that could be used for other Patients. That shouldn’t concern you in any way but you need to know and understand what is most likely going on in the background so that you understand the most likely dynamics behind the decisions that are being made. This is important for you to know in your situation and don’t be hesitant to ask those distinct questions and don’t be hesitant to challenge the Intensive Care team if you feel like you are not getting heard. It is also inappropriate that you feel like you are not getting the time you want and need with your husband that would give you more peace of mind. It is also important that you let the Intensive Care team know that you are waiting for your husband’s brother and that you wish him to be there when your husband is passing away. Some Intensive care units are very good when it comes to end of life care and other Intensive Care Units still have room for improvement when it comes to end of life care. It sounds to me like your husband has been admitted to an Intensive care unit that has lots of room for improvement in the domain of end of life care. It is therefore even more important for you to challenge the Intensive Care team. Many, if not most Intensive Care units, would accommodate your wishes regarding your husband’s end of life situation and they would happily give you and your family the time in order to come to terms with your difficult situation. It also sounds to me like you and your family have accepted the clinical facts that your husband is going to approach his end of life, however if you still don’t have peace of mind, just go and ask for a second opinion from either another Intensive Care consultant or maybe from a neurologist or neurosurgeon. They often have a differing view from the Intensive Care team, as their prime interest is not so much what is happening in Intensive Care. Their interests are usually very specific to the brain and they may offer you different points of view, also regarding your husband’s end of life situation. If you go out there and ask for other opinions, you might also get the time you need for you and for your family to come to terms with your husband’s situation and you and your family may find peace of mind. What you can also do is read our Free “INSTANT IMPACT” report. In this FREE report you can immediately improve your and your family’s life whilst your loved one is critically ill in Intensive Care. Get your Free “INSTANT IMPACT” report by entering your email address below or at the sidebar. In this free report you’ll discover • how to ask the doctors and the nurses the right questions • how to eliminate fear, frustration, stress, struggle and vulnerability • 5 “killer” tips& strategies helping you to get on the right path to control, power and influence in your situation • you’ll get ‘behind the scenes’ insight so that you understand what is really happening with our FREE “INSTANT IMPACT” report you’ll also get four other FREE reports that will help you to take control, have real power and influence decision making when your loved one is critically ill in Intensive Care the four other free reports you’ll get are • “7 answers to the 7 most frequently asked questions, if your loved one is a critically ill Patient in INTENSIVE CARE “ • “9 myths of being a critically ill Patient in Intensive Care” • “6 questions you need to ask the most senior doctor in Intensive Care if your loved one is critically ill in Intensive Care. You’ll also get one bonus question at the end of the report” • “10 things doctors and nurses are talking about if your loved one is critically ill in Intensive Care when you and your family are not present at the bedside” Sincerely, your friend PatrikEvelyn from Dallas, Texas, USA My 78 year old father has been admitted to Intensive Care in the last week with an Abdominal Aneurysm Repair and he hasn’t woken up out of the induced coma as yet and he is still ventilated with a breathing tube. I’m very worried that he might not recover and the doctors are telling me that it might be a while before he gets better. Furthermore, it looks like his kidneys have taken a hit and the doctors are now talking about dialysing him and putting him on the kidney machine. Out of that I have two questions. Number one, what do you think my father’s chances of recovery are and if he does recover, would he need dialysis for the rest of his life? Dear Evelyn, Thank you for your question. In order to answer your question, you need to know that Abdominal Aneurysm Repairs(‘AAA’ or ‘triple A’ repairs in the medical jargon) are usually rarely straightforward and most Patients, especially above the age of 60 do not recover quickly in Intensive Care. It comes with the territory and ‘AAA repairs’ are a massive event, as the Patients tend to lose large amounts of blood during surgery as the aorta is the major vessel, carrying a lot, if not the vast majority of the human blood. Patients in Intensive Care can therefore be very unstable and critical after surgery and that generally delays the recovery time. With that in mind, Patients tend to get donor blood during and often after the operation as well in order to make up for the loss of blood. Often Patients might have lost blood on their way to hospital/ surgery as well, as AAA repairs can be emergency cases as well. Moreover, AAA repairs tend to be lengthy surgical procedures with some cases lasting up to 12-14 hours surgery time. That’s a long time and generally the older Patients are the longer it takes them to a) Recover from the surgery in Intensive Care b) Get out of the induced coma and also get off the ventilator The other thing that often does go hand in hand after ‘AAA repairs’ is kidney or renal failure. The reason for that is that when the Aorta is being repaired, both ends of this large vessel are being clamped in order to stop blood flowing during surgery for the repair and at the same time, given that the aorta is supplying all major organs including the kidneys with blood, the blood flow to the kidneys is interrupted during surgery. Given the long surgery times, the longer the kidneys are without blood supply, the higher the likelihood of your father going into kidney or renal failure after surgery. You may want to check, maybe your father also has pre- existing kidney impairments, but it’s nothing unusual to go into kidney failure after ‘AAA repair’. As I have mentioned above, surgery times can be extremely long for ‘AAA repairs’ and that in combination with your father’s age are likely contributing to your father’s recovery time. Keep in mind that Aortic abdominal aneurysms are life threatening and that there is a reason why your father has been admitted to Intensive Care. Because your father had lots of anesthetics during surgery and he is still in Intensive Care requiring some form of sedation for tolerating ventilation and generally for comfort and for pain relief, would also contribute to him not waking up and he may well need more time. Also contributing to this would be his kidney failure, because if his kidneys aren’t working properly, it takes longer for the body to get rid of and metabolise the sedation and pain medication and therefore he might have too much sedation floating around in his body, prolonging his stay in Intensive Care and not ‘waking up’. Regarding your father’s kidney failure and whether he would need life long dialysis. It depends on whether your father has had kidney problems in the past and it also depends how much damage has been done to the kidneys during surgery and how long the kidneys have been without sufficient blood supply. Usually, most Patients in Intensive Care requiring (Haemo) dialysis only require the dialysis intermittently and the kidneys recover fully. Having said that, some Patients after ‘AAA repair’ do require dialysis after their stay in Intensive Care for the rest of their lives. Please don’t hesitate to ask the doctors and nurses as many questions as you can and also read our “INSTANT IMPACT”report and get it by leaving your email address in the form below, because that will help you getting control back in your life whilst your loved one is critically ill in Intensive Care! I hope those answers help and I wish you and your family all the best during this difficult time in your life! Sincerely, your friend Patrik