My name is Patrik Hutzel from intensivecarehotline.com, where 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, even if you’re not a doctor or a nurse in intensive care. This is another quick tip for families in intensive care.

I have worked in critical care nursing for over 25 years in 3 different countries, where I worked as a nurse manager in intensive care, and I’ve been consulting and advocating for families in intensive care since 2013 at intensivecarehotline.com.

Today I’m answering an urgent question from Celine, who wrote to me and says:

“Hi Patrik, 

My mom had brain surgery 3 weeks ago. She’s in ICU, and they want to remove the ventilator tomorrow and use nasal oxygen. I’m wondering what her chances of survival and move her to a ward. It’s urgent — what can we ask for home life support options?”

From Celine.

I understand, Celine, how frightening this moment is, and you’re being asked to accept a major change in your mom’s care on very short notice. You deserve clear and concise information to help you make the best decision for her. Let’s work through this together.

1. Understanding Your Mom’s Situation Right Now

Your mom had brain surgery 3 weeks ago and is still in ICU. Based on what you’ve shared, she’s currently partially weaning on pressure support ventilation, meaning the ventilator is still doing some of the breathing work, and her level of consciousness is minimally conscious with inconsistent responses. The ICU team wants to extubate her tomorrow and move her to nasal high-flow or low-flow oxygen.

Importantly, there appears to be no clinical reason clearly communicated to you. This raises the real possibility that bed pressures are a factor.

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 exactly what you’re dealing with here, because what you need to know right now is that extubation, the removal of the breathing tube, after brain surgery is a high-stakes decision.

Doing it too early, especially when the patient is only minimally conscious, significantly increases the risk of respiratory failure, aspiration, and the need for emergency reintubation. Being minimally conscious does not mean your mother is safe to breathe independently. Inconsistent responses mean her brain’s control of breathing, swallowing, and airway protection may be unreliable.

2. Questions Family Must Ask Before Extubation

Celine, you have every right and obligation to ask hard questions before this happens. Here is what I would ask the ICU team:

Has my mother passed a formal spontaneous breathing trial (SBT)? What were the results? What is her Glasgow Coma Scale right now, and what was it before surgery? The Glasgow Coma Scale is a neurological assessment tool that gives you a good indication of your mom’s level of alertness and consciousness, and depending on the score, you can ascertain whether it’s safe to extubate or not.

You also need ventilator settings and arterial blood gases, which give you a very good indication of whether it’s safe for your mom to extubate or not. Can she protect her own airway — coughing, swallowing, managing secretions? What is her current respiratory rate, tidal volume, and oxygen saturation on minimal pressure support? What is the plan if she fails extubation — will she be reintubated? Why is this happening tomorrow specifically, and what is driving this timeline? Has a neurologist reviewed her readiness for extubation? If she is moved to a ward, who will monitor her breathing overnight?

Here’s one of my tips: you’re allowed to say, “We do not consent to extubation tomorrow until we have had a full family meeting with the treating team and a clear explanation of the clinical reasoning.” The ICU team must respect this.

Intensive care teams are the masters at pretending they can do whatever they want, regardless of the outcome, because a premature extubation could kill your mom. Don’t fall for the idea that the intensive care team can just do whatever they want without being challenged, because the minute you challenge them, they back off. That is my experience from over 25 years of critical care nursing. Do not take no for an answer here.

3. What Are the Treatment Options for Your Mom?

First option: Proceed with extubation and nasal oxygen. If clinical criteria are genuinely met — she passes a spontaneous breathing trial, her airway reflexes are intact, neurology is satisfied — extubation may be appropriate. Nasal high-flow oxygen or standard nasal cannula oxygen can then support her breathing, potentially also non-invasive ventilation such as BiPAP or CPAP. This would be the best outcome if she is truly ready.

Second option: Non-invasive ventilation (BiPAP or CPAP). If there’s a concern about her ability to breathe fully and independently, but the team still wants to trial extubation, non-invasive ventilation via a face mask is a crucial middle step. NIV, such as BiPAP (Bilevel Positive Airway Pressure) or CPAP (Continuous Positive Airway Pressure), provides breathing support without a tube in the airway. It is widely used post-extubation in neurological and post-surgical ICU patients to prevent failure and avoid reintubation.

NIV stands for non-invasive ventilation. It delivers positive pressure through a tight-fitting mask, BiPAP, or CPAP, without intubation. It supports breathing, reduces the work of breathing, and can be lifesaving if extubation is attempted before a patient is fully ready.

Third option: Tracheostomy if she cannot be weaned. If your mother’s brain injury means she’s unlikely to sustain independent breathing in the near term, a tracheostomy is a far safer and more comfortable long-term airway solution than keeping an endotracheal tube in place. A tracheostomy is: (1) more comfortable for conscious or minimally conscious patients; (2) allows for gradual weaning from the ventilator over weeks or months; (3) reduces the risk of aspiration  and airway complications; (4) enables the patient to potentially speak and eat with the right valves and support; and (5) is essential if long-term ventilation at home is being considered.

Fourth option: Return to full ventilation or reintubation if extubation fails, which is a real risk given her current neurological state. She will need emergency reintubation. This is much more likely given how you’re describing things, and it is more traumatic and carries higher complication risks than a planned, well-timed extubation.

This is exactly why families should push back on premature extubation driven by bed pressures, financial pressures, or staffing pressures rather than clinical readiness. What intensive care teams are now facing is huge bed pressures, huge financial pressures, and often huge staffing pressures — meaning a lot of ICUs don’t have enough staff. You might see empty beds and think there’s no shortage, but it is very often a sign that they don’t have enough staff. An ICU that can’t attract or keep staff is a red flag in itself, because it often means the culture of the ICU is not great, which impacts negatively on patient care. Keep that in mind and ask all the right questions.

The Risk of Extubation Failure

Emergency reintubation carries a higher risk of hypoxia (low oxygen), aspiration, cardiac events including cardiac arrest, and neurological deterioration. A failed extubation can undo weeks of ICU progress. If the ICU team cannot clearly explain why she’s clinically ready now, it is reasonable to request a delay.

Why Medical Records Are Critical Right Now

Celine, one of the most powerful things you can do as a family member in intensive care right now is request access to your mom’s complete medical records. This includes daily nursing and medical notes, ventilator settings, weaning progress charts, neurological assessments and Glasgow Coma Scale scores, results of any spontaneous breathing trials, imaging reports such as CT and MRI scans, chest X-rays from before and after surgery, list of medications, lab results, and all documented discussions about goals of care and discharge planning — including discussions you have not been part of.

Why does this matter? Because the medical records tell you whether the decision to extubate is driven by your mother’s clinical improvement or by hospital bed pressure. It also gives you the information you need to ask informed questions, advocate effectively, and seek a second opinion if necessary.

Remember, you have a legal right to these records in all jurisdictions. Patients and their authorized representatives have the right to access medical records under law in any jurisdiction. If they’re delaying access to medical records, that’s a red flag — what is it the hospital has to hide, what is it that they’re worried about you seeing? Request them in writing to the ICU unit manager or medical records department now. Don’t wait — get them now while decisions are being made.

As a bonus tip: in this day and age, all they should do is give you a username and password so you have access to the medical records through a website, a URL, or by downloading an app. It should be no more complicated than that. Anything more complicated than that, you should be worried about what they’re trying to hide.

How Intensive Care Hotline Can Help You

Celine, and any family in a similar situation — this is exactly what our consulting service at intensivecarehotline.com exists for. When you work with me, my team and I review your mom’s medical records  with you and identify any red flags, participate in three-way calls with you and the ICU team to ask the clinical questions they may not volunteer, and ask the clinical questions you haven’t even considered but must be asked in a situation like this.

We will advocate for your mother’s right to remain on the ventilator until she’s genuinely ready for extubation, and help you understand what non-invasive ventilation, tracheostomy, home ventilation, and Intensive Care at Home options look like in your specific situation. We are your expert and voice in the room or on the phone when you need it most.

Go to intensivecarehotline.com, call us on one of the numbers at the top of our website, or send an email to [email protected]. 

If Your Mother Needs Long-Term Ventilation or a Tracheostomy: Intensive Care at Home

If your mom’s brain surgery has left her ventilator-dependent — whether she needs a tracheostomy, long-term invasive ventilation with a tracheostomy, non-invasive ventilation without a tracheostomy, or a tracheostomy without ventilation — she doesn’t have to remain in ICU or in hospital indefinitely.

With Intensive Care at Home, we provide full home care for ventilator-dependent patients, with or without a tracheostomy. We operate across Australia, in all major capital cities and in regional and rural areas, and we are third-party accredited. If you’re watching this from the US or the UK, you should also reach out to us — we can help you there privately.

We support patients at home on long-term invasive ventilation with a tracheostomy, long-term non-invasive ventilation with BiPAP or CPAP, and tracheostomy care without ventilation — all delivered by 24-hour critical care nurses, similar to an ICU It just means we’re bringing the intensive care into your home, so that it’s patient- and family-friendly, and so we can help ICUs free up their precious and in-demand beds. Third-party funding is often available, and we can help you with the funding and advocacy as well.

Why home ventilation? Patients cared for at home by specialist critical care nurses 24 hours. a day have better quality of life fewer, if any, hospital-acquired infections, no hospital readmissions, and a predictable, stable pathway that keeps them out of ICU permanently and predictably, with quality of life. In countries like Germany and Australia, this solution has been around for decades, and we’re now bringing it to the United States and the UK as well.

Call us at intensivecareathome.com to discuss your specific case and to go home with your family member.

Conclusion

Celine, you are your mother’s best advocate. Your instinct to question the decision is the right one. An ICU team wanting to extubate a minimally conscious, partially weaning, post-brain-surgery patient with no clear clinical trigger given to the family deserves scrutiny, because this sounds like it could be life or death.

You have the right to ask for a full family meeting before any extubation. But before you go to a family meeting, you need to have access to all medical records — make attending the family meeting conditional on having that access. Don’t let them tell you to jump while you ask how high. Put your parameters and demands in place; that’s really important.

Again: request your mom’s complete medical records; ask for non-invasive ventilation as a safety net post-extubation; ask for reintubation as a safety net post-extubation; ask whether a tracheostomy is more appropriate; seek a second opinion from a neurologist and/or a respiratory specialist; contact us at intensivecarehotline.com for expert guidance today; and keep in mind that Intensive Care at Home is also an option.

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.

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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.