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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care. So, the videos that I’m making here are really just feedback from clients and from readers, and I’m just really reading out what they are sharing with us, what their frustrations are, what their problems are.

So, we can help them here very fast because as I always say, 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 you will see very quickly that this particular reader is dealing exactly with that. They don’t know what they don’t know.

Also, I do regular YouTube Live, so I go on a live stream once a week. It’s usually at 8:30 PM on Saturday Eastern Standard Time in North America. It’s 10:30 AM Sydney, Melbourne time in Australia, 5:30 PM on a Saturday Pacific Standard Time, and I’m at 10:30 AM Sydney, Melbourne time on a Sunday, 8:30 PM Eastern Time on a Saturday evening or Saturday night in North America. So, look out for those live streams because there I answer questions as well and I can answer your questions on a live stream even.

Let’s dive into today’s frustration from one of our readers who says, “My sister has been in ICU for five weeks. They’re now talking about doing a tracheostomy after she’s been on the ventilator and in ICU for five weeks. Is this the right step?” Now, that’s a great question and if you look at some of my other videos, there would be videos around topics like, “How long can a breathing tube stay in?” or “When should a tracheostomy be done?”. And quite frankly a tracheostomy should be done after about two weeks in intensive care of mechanical ventilation with a breathing tube and an induced coma. Assuming there is the inability to wean someone off a ventilator. And that may well be the case with your sister. So, if she’s been on a ventilator for five weeks, can’t be weaned off the ventilator, then a tracheostomy needs to be done.

But here’s the problem, again, a tracheostomy should have been done after about 10 to 14 days of the inability of weaning off the ventilator. Why did they wait so long? So, here’s the problem.

When someone is in an induced coma and on a ventilator with a breathing tube, every day they’re in an induced coma, they’re deconditioning fast, making it even harder for them to wean off a ventilator. It’s a vicious cycle.

So therefore, if someone has shown that they can’t be weaned off a ventilator, you need to move towards a tracheostomy very quickly because then sedation and opiates can be switched off. One of the main side effects of opiates and sedation is respiratory depression. I.e., the natural respiratory drive is inhibited, making it even harder to wean off the ventilator down the line because the breathing muscles are wasted from the induced coma from not moving, from the ventilator doing all the work for patients in intensive care.

So therefore, the ICU has not acted in the best interest of your sister. That tracheostomy should have been done after Day 10, Day 14 of the inability of weaning off a ventilator. So, what to do from here? Well get the tracheostomy done as quickly as possible.

Again, that’s assuming your sister can’t be weaned off the ventilator. One question that I would have for any family in ICU, well, what is the ICU doing beyond the shadow of a doubt to get your sister off the ventilator? And it has to be proven beyond the shadow of a doubt, which is where we are coming in and where we can help. We can advise you and we can talk to them whether they have done everything beyond the shadow of a doubt. We can be your advocate and your consultant. We can be the voice for you, which you inevitably need in a situation like that as has already been shown.

Because if you had known what to expect and if you had reached out to us for a second opinion, we could have guided you in the right direction from Day 1. ICU’s often have their own agendas. They’re not always acting in the best interest of a patient. Clearly, leaving someone in an induced coma for five weeks is not in your sister’s best interest. There are exceptions to that rule. Like, if ventilator settings have been too high, maybe they couldn’t do a tracheostomy earlier. Maybe FiO2 (fraction of inspired oxygen) was too high, maybe PEEP (positive end expiratory pressure) was too high. There might have been exceptions to the rule, and you haven’t shared why your sister is in ICU.

However, most of the time, a tracheostomy can be done safely, and I’m sure you would’ve mentioned it in your email that they couldn’t do a tracheostomy because your sister has been too unstable.

So, if you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website, or simply send us an email to [email protected] with your questions.

Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There you have access to me and my team 24 hours a day in a membership area and via email, and we answer all questions, intensive care and Intensive Care at Home related.

Also, if you need a medical record review, please go to intensivecarehotline.com as well, and we can help you with a medical record review in real time when your loved one is in intensive care and give you that crucial second opinion. But we also talk to doctors and nurses directly, ask questions on your behalf and advocate for you in real time and fast.

If you need a medical record review after intensive care because you need closure, you have unanswered questions, or you are suspecting medical negligence, please contact us as well. We can help you with that as well.

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

Thanks for watching.

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

Take care.