Hi, it’s Patrik Hutzel from intensive care hotline.com with another quick tip for families in intensive care.
So Rodney sent us an email and he writes in and he says, my dad is in the ICU from COVID-19 and he’s in an altered mental status. He’s on a ventilator at the lowest setting and can breathe on his own. But being weak from being in ICU, they are worried. He can’t keep down secretions and he’s not fully waking up. He opens his eyes and makes grimaces, he’s not sedated at all. What can we do to help him wake up and get off the ventilator?
What a great question, Rodney and that’s the situation many COVID-19 patients are currently facing. They get in ICU, get intubated, get in an induced coma, and then they can’t wake up and they can’t come off the ventilator. So what can you do to help him and get him off the ventilator?
So there’s a number of things that are going to happen if he can’t get off the ventilator, let’s look at them first.
First of all, your dad might end up with a tracheostomy, which is a breathing tube in the neck and you want to avoid that at all costs. At the same time, about the two-week mark, which is where your dad is at, a tracheostomy is actually recommended.
So unfortunately your dad doesn’t have a lot of time to try and avoid the tracheostomy. So definitely he needs to wake up, need to make sure that he’s off all sedatives and all opiates. Opiates is pain relief. You need to make sure that he can cough and clear his airway.
If he can’t cough and if he can’t clear his secretions, he might need a tracheostomy. So he needs therefore chest physiotherapy or chest physical therapy. He needs to be able to take deep breaths and he needs to be able to cough and the cough needs to be strong enough so he can clear his secretions without needing suctioning.
Next, if he’s able to take the breathing tube out himself with his hands, that’s a very good sign that he might be able to come off the ventilator.
Next, his arterial blood gases need to be good enough. So again, that is another sign that he can breathe by himself sufficiently so that he can wake up, that he can be extubated and get off the ventilator.
Next, his chest x ray needs to be clear. And again, that would be another sign that he can come off the ventilator.
So those are the main things. Also, you need to keep in mind that if he ends up with a tracheostomy, he might be stuck in ICU or even worse in LTAC for a long time to come. And again, you want to avoid that at all costs because the recovery without a breathing tube and without a ventilator, as opposed to with a tracheostomy and with a ventilator is like day and night.
If your dad can come off the ventilator and the breathing tube, now you will most likely be moved to a hospital ward where his recovery can progress fairly quickly.
Or if he ends up with a tracheostomy and a ventilator, he might end up with that for a long time to come. And again, he might be stuck in ICU, or he might be stuck in LTAC, which is even worse.
The better alternative if your dad ends up with the ventilator and the tracheostomy, simply he could go home with a service like intensive care at home.
I hope that helps Rodney. It sounds to me like you need more help, please contact us at intensivecarehotline.com. Give me a call on one of the numbers on the top of the website, or just simply send me an email to [email protected].