My name is Patrik Hutzel from Intensive Care Hotline, and this is another quick tip for families in intensive care.

Here at Intensive Care Hotline, we instantly improve the lives of families of critically ill patients in intensive care so that you can make informed decisions, have peace of mind, control, power and influence, making sure your loved one always gets the best care and treatment, even if you’re not a doctor or a nurse in intensive care.

Today, I’m answering a question from Deborah, who has her 81-year-old dad in ICU. Deborah says the following.

Her 81-year-old father fell off a ladder and hit his head on concrete. He was airlifted to a trauma ICU with a subarachnoid and subdural haemorrhage.  He progressed well until day 10, when a thick mucus plug caused him to stop breathing during suctioning. He was rushed to ICU, placed on a ventilator and subsequently developed pneumonia, an ischemic stroke, sepsis, and fractured ribs.  Then, a small miracle: the team removed the ventilator, He was breathing on his own. When asked his name, he answered correctly. He also told the staff to leave him alone, which Deborah sees as a very good sign.

Deborah asks, what should they be watching for, and what questions should she ask?  Stay with me for the answers.

Now, in case you’re wondering what makes me qualified to answer questions like Deborah’s, again, my name is Patrik Hutzel. I’m a critical care nurse, having worked in critical care nursing for over 25 years in three different countries, where I worked as a nurse manager for over five years in intensive care.  I’ve been consulting and advocating for families in intensive care since 2013 here at Intensive Care Hotline. I can confidently say that we have helped save many lives for our clients in intensive care. You can verify that in our testimonial section and on our Intensive Care Hotline podcast section, where we have done client interviews.

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Get All of Your Dad’s Medical Records

Deborah, get all of your dad’s medical records. Not a verbal update, not a summary, all of it: CT (Computed Tomography) scans, MRI (Magnetic Resonance Imaging) reports, blood cultures, nursing notes, doctor’s notes, lab results, medication lists, ventilator settings, vital sign parameters, fluid balance charts, everything. Leave no stone unturned.  You have a legal right to those records, and you cannot advocate effectively without them. If you need help understanding what they contain, that is exactly what a consulting call with me at intensivecarehotline.com is for.

Let me put this in plain language and explain what his body has been through.  Your father’s body has survived a traumatic brain bleed, an airway emergency caused by a mucus plug, ventilator-associated pneumonia, an ischemic stroke, sepsis, and fractured ribs. Each one of these alone is extremely serious. Together, they are extraordinary. The mucus plug on day 10 was the turning point. Oxygen stops reaching the brain and organs within minutes when the airway is blocked. That event may have triggered the stroke and worsened the infection cascade.  And yet, he came through it.  He’s breathing on his own. He answered his name. He told the staff to leave him alone.  That is what clinicians call a purposeful, volitional response.  He’s still in there, and that is remarkable.

What to Watch for After Extubation

Extubation, which is the removal of the breathing tube, is a milestone, not the finish line. The next 24 to 72 hours are still critical.

Here’s what to monitor.

1. Breathing

• Respiratory rate between 12 and 20 breaths per minute.
• Oxygen saturation above 92–94%.
• No accessory muscle use.
• Ability to manage his own secretions.
• Minimal use of opioids such as fentanyl, morphine, and oxycodone.

One of the main side effects of opioids is respiratory depression. This is especially important because your dad has just been extubated and has fractured ribs.  He must breathe properly. If he can’t breathe properly or take deep breaths, he may develop another pneumonia and need to be intubated again.  I’ve seen countless patients in ICU being extubated, only for opioids to be continued because of inadequate pain management. Those patients then had to be reintubated.  It’s really important that pain is well controlled. There should be no overuse of opioids, but you also need to find the balance. Your dad’s pain needs to be well controlled while he remains able to take deep breaths so that his lungs can expand and he can cough to bring up sputum.  Otherwise, if the sputum and mucus don’t come up, he’ll develop pneumonia.  What will also help is getting your dad mobilised.  If he can sit in a chair, that helps his lungs expand and may help reduce the risk of pneumonia.

2. Neurology

Monitor whether he is consistently following commands, whether his speech is becoming clearer, and whether there are any new focal neurological deficits.  Has a formal swallowing assessment been done by speech pathology?  Nothing by mouth until that is completed.  Also, watch for delirium.  Acute confusion is very common in elderly ICU patients and is separate from the underlying brain injury.

3. Infection

Monitor whether his temperature and white blood cell counts are trending towards normal and whether the antibiotic course is nearly complete.

4. Pain Management

His fractured ribs are dangerous, not just because they hurt, but because pain stops him from breathing deeply and coughing.  That creates the conditions for further pneumonia. Adequate analgesia is not optional, but overuse of opioids must be avoided.  As I said, get him out of bed and sitting in a chair so that he can breathe deeply, do coughing exercises and breathing exercises, and expand his lungs.

Questions to Ask the ICU Team

Write these down and bring them to the ward rounds.

1. What caused the stroke?

Has the source been identified, and what is being done to prevent another one?

2. What grew on the blood cultures?

Is the antibiotic course nearly complete?

3. Has speech pathology done a formal swallowing assessment?
4. Who are all the specialists currently involved in his care?

Neurology, infectious disease, physiotherapy, dietetics, and speech pathology should all be involved.

5. What does the rehabilitation plan look like after ICU step-down?

If you’re not getting clear answers to these questions, call me. That is exactly what we do here at Intensive Care Hotline.

An Alternative to Long-Term Hospitalisation

For any family watching where long-term ventilation or a tracheostomy is being considered for similar situations, there is an alternative to indefinite hospitalisation and ICU stays.

My other organisation, Intensive Care at Home , provides third party-accredited specialist home nursing services for ventilator-dependent patients. We are ISO 9001 certified and NDIS registered, with hundreds of years of combined critical care nursing experience in the community for ventilated and tracheostomy patients.

We support patients requiring BiPAP (Bi-Level Positive Airway Pressure) , CPAP (Continuous Positive Airway Pressure), non-invasive ventilation, and tracheostomy care with or without ventilation. We help make these arrangements possible so that your family member may not have to stay in ICU long-term.

Visit www.intensivecareathome.com.

Intensive Care at Home currently operates throughout Australia, across all states and territories. We also help families in the US, Canada, the UK, India, and wherever else we can provide assistance. Reach out to us wherever you are.

How Intensive Care Hotline Can Help Your Family

Deborah, you’ve already said that your father is not your average 81-year-old. The fact that you’re asking these questions means he has the right family in his corner.  If your loved one is in ICU right now and you need support, call me at intensivecarehotline.com using one of the numbers at the top of our website, send us an email at [email protected], or book a free 15-minute appointment on the website. I also offer paid consulting and advocacy options beyond the free 15 minutes.

Subscribe to my YouTube channel. If this helps, leave a comment below. I’ll read every one of them. Let me know what videos you would like to see and what questions you have, and I’ll get them published here for you.

Take care of yourselves and take care of each other.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over five years in intensive care. And I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. And I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights, and you can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section, where we have done client interviews.  And because our advice is absolutely life-changing, right?

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for, they don’t know what questions to ask, they don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. And that’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always. And that’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

And that’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. And I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. And when I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.  I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care, so, if, in case you have unanswered questions, if you need closure or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com. If you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team 24 hours a day in the membership area and via email, and we answer all questions intensive care-related. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. And all of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

And all of that you get at intensivecarehotline.com. Call us on one of the numbers at the top of our website or simply send us an email to support at intensivecarehotline.com with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have from this video.

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where I answer your questions live on a show and you will get notification from the YouTube Live if you are a subscriber to my YouTube channel or if you are a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com. 

Your FREE Download: ICU Family FAQ: Wife in a Coma After Cardiac Arrest

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.