My name is Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care. 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 have a message that I received from a family member named Devi, and I want to address it.  Because what Debbie and her family are going through right now is one of the most painful situations a human being can ever face.

So, Debbie writes:

“Hi, Patrik.

Our mom has been in the ICU, on a ventilator, since Friday, the 27th of April, after being admitted with pneumonia.

Three days ago, the medical team took her off sedation, and she has not woken up.  Her EEG (electroencephalogram) is showing signs of brain trauma, and she’s not responding to any stimulation. The doctors are now asking us to make a decision about removing her from the ventilator.”

Debbie, this video is for you, and it is for every family watching right now who’s in that same waiting room, holding that same fear.  Let me start with the clinical picture, Debbie, because I want you to fully understand what has happened to your mother’s body: the pneumonia, the sepsis, and the acute kidney injury.

She was admitted with pneumonia, which is a lung infection. That infection then progressed to sepsis.  Sepsis is when the body’s immune response to infection goes into overdrive and starts damaging its own organs. It is one of the most serious conditions we see in the ICU, and in her case, it also caused acute kidney injury (AKI) meaning her kidneys have been affected.  She has been on a ventilator since admission because her lungs could not sustain adequate breathing on their own.  That is not unusual with severe pneumonia and sepsis. The ventilator is keeping her alive while her body fights.

Now, why has she not woken up?  Three days ago, the team stopped her sedation. She has not woken up. She’s not responding to stimulation, and I know that must be terrifying for you and your family.

There are two different explanations for why a patient does not wake up after sedation is stopped, and they have very different implications for prognosis.  The first explanation is sedation hangover. Some sedative medications, particularly in elderly patients or those with kidney or liver impairment, can take many days to clear the body fully. This can look like unconsciousness, but it’s actually a prolonged drug effect.  It is reversible.  The second explanation is brain injury, specifically sepsis-associated encephalopathy or hypoxic-ischemic brain injury caused by low oxygen or low blood pressure during the acute illness.  This is more serious and can range from fully reversible to permanent, depending on the extent of damage.

The EEG (electroencephalogram) is being used to try to differentiate between those two possibilities. That is why what the EEG actually shows matters enormously, and I will come to that now.

Signs of Brain Trauma and What the EEG Means

That is a phrase that can mean many very different things on an EEG. Let me explain. Diffuse slowing on EEG, meaning the brain activity is slower than normal across the whole brain, can be caused by metabolic disturbance, medication effects, or early brain injury. It can be reversible.  Burst suppression, where the brain flicks between flat periods and bursts of activity, is more serious and suggests significant brain injury or very deep sedation.  An isoelectric or flat EEG, meaning no brain activity, would be the most concerning finding of all.  Debbie, you need to know exactly which of these your mother’s EEG shows.  Ask for the written EEG report. Ask for a neurologist to explain it to you in plain language. That is your right.

If you are watching this and you have been given a vague verbal summary of a test result and asked to make life-or-death decisions based on it, please stop.  Please pause. Get all medical records, get all written reports, and get a second opinion.  Call us here at intensivecarehotline.com right now.

Will Your Mother Recover?

I cannot tell you if your mother will recover or not. I cannot promise you that.  No clinician who has not reviewed her full records and who doesn’t have extensive experience should make that promise.  But I can tell you what factors most influence prognosis in this situation.

• The severity and cause of the infection. Is it resolving with treatment?
• How long was her blood pressure dangerously low before the ICU? Because that drives brain and organ injury.
• The exact EEG findings and any brain imaging results.
• Whether kidney function is improving or deteriorating.
• How long it has been since sedation stopped. Three days is concerning, but in sepsis-associated encephalopathy, some patients have awakened after 10 or 14 days.
• Her pre-admission health and cognitive baseline.

Prognosis is not a single number. It is a conversation, and that conversation needs to happen with full information, a neurologist at the table, and your family’s advocate in the room.

Four Options You Should Consider Before Making a Decision

Debbie, the ICU team has presented this as a binary choice: continue or withdraw treatment. But there’s more nuance available to you, and you have the right to explore it.  It’s very rarely black and white. It is often grey, and there’s a happy medium.

Option 1: Request a time-limited trial.  Ask the team to continue treatment for a defined period, say, 7 to 14 days, and reassess at that point with a formal neurological review. This is a recognized ethical approach in ICU medicine.

Option 2: Request full investigations before any decisions.  Has she had a brain MRI (magnetic resonance imaging)? Not just a CT scan (computed tomography scan), an MRI.  Has a neurologist formally reviewed her EEG?  Have all sedative medications fully cleared?  These questions need to be answered before a withdrawal decision is even discussed.

Option 3: Consider a tracheostomy.  If she shows neurological improvement but cannot be weaned off the ventilator, a tracheostomy can be placed.  This is a surgical airway in the neck that is better tolerated for longer-term ventilation and opens the door to rehabilitation and potentially going home with Intensive Care at Home.

Option 4: Consider palliative care if recovery is not realistic.  If investigations confirm that there is no realistic prospect of meaningful recovery, palliative care and withdrawal of treatment and life support and ventilation can be a humane, ethical, and dignified option.  But Debbie, that decision should be made by your family, and by your family only, with full information, not under pressure.

The first question you should be asking when someone is suggesting a withdrawal of treatment, with not much time spent in the ICU, is: Where’s the urgency? Where’s the rush to kill your loved one?  The next question you should be asking is: Why are not all resources being made available to save your mother’s life?  Always ask yourself: Where’s the rush? The urgency to kill someone? Why is there no rush to save someone?  Never make decisions today that you could regret in 12 months’ time or 24 months’ time.  I can’t tell you how many families come to us here at intensivecarehotline.com, and they tell us:  “My loved one’s treatment was withdrawn in the ICU 12 months ago. It happened after 3 or 4 days in the ICU. We had no idea what we were dealing with. We gave in, and now we have second thoughts.” Well, you should have had those second thoughts right there and then, and now you’re regretting it, and now it’s too late.  Think about that.  Do not make emotional decisions. Make slow, informed decisions.  Because that also gives your mother time to recover.  Buy Time with Advocacy.

Next, get all medical records.  And I say this to every family I speak with, and I will say that to you now: Get all of your mother’s medical records, every nursing note, every blood result, the full EEG report, the full CT and MRI reports, the medication chart, and the ventilator parameters.  You are being asked to make one of the most important decisions of your life based on verbal summaries in corridor conversations. You deserve the full picture.  Legally, in the United States, in Canada, in Australia, in the UK, in Ireland, in India, you name it, you deserve the full picture.  And you have every right to access medical records.  And I mean all medical records, not just what the intensive care team wants to show you.

My team and myself at intensivecarehotline.com will review those records with you, we will explain them in plain language, and we will speak directly with the ICU team on your behalf, asking the clinical questions that need to be asked.

How We Help at Intensive Care Hotline

Here’s how we help at intensivecarehotline.com.  We have helped thousands of families all around the world, mainly in the US, Canada, UK, Australia, New Zealand, and many other countries around the world, to navigate exactly these situations.  We are not lawyers. We are not administrators.  We are clinicians, experienced critical care registered nurses, and ICU specialists, people who have stood at the bedside in the ICU and in critical care for decades.  And we have seen it all.

We understand intensive care inside out. We know how ICUs operate on an administrative level. We know how ICUs operate on a financial level. We know how ICUs operate on a mindset level. We know how ICUs operate on a resource level, whether it’s staff, equipment, and the list goes on.

Intensive Care at Home: An Alternative to Long-Term ICU

Now, let’s look at a viable alternative if your mom needs ventilation, a tracheostomy, ventilation without a tracheostomy, or a tracheostomy without ventilation.  Because if your mother shows neurological improvement, if she stabilizes, but she remains dependent on a ventilator, either through a tracheostomy or non-invasive ventilation, such as BiPAP (bilevel positive airway pressure) or CPAP (continuous positive airway pressure), she does not have to stay in an ICU for the rest of her life.  Because intensivecareathome.com provides a genuine alternative to a long-term stay in intensive care.

Intensive Care at Home  is the only intensive care at home nursing service that is third-party accredited.  Currently, we’re operating all around Australia, in all states and territories, in all metropolitan and regional areas, and in all remote areas.  We operate all around the country.  We provide 24/7 critical care nursing in the home, the same level of clinical care your mother receives in the ICU, delivered at home, where your family can be around her.  With support, adults and children on invasive ventilation with a tracheostomy, non-invasive ventilation with BiPAP, CPAP, or a tracheostomy without ventilation, but also conditions like where patients need home TPN (total parenteral nutrition) and PEG (percutaneous endoscopic gastrostomy) tubes, and nasogastric tubes.  And the list goes on.

If you’re watching this and you’re in the US, in the UK, or in Canada, I want you to reach out to us as well for Intensive Care at Home.  We can help you there as well.  Go and check out intensivecareathome.com to learn more about what we do now.

A Message to Debbie and Every Family in ICU

Now, Debbie, you said that more than anything, you just want to be by your mother’s side, to hold her hand, to let her know you are here.  Do that.  Keep doing that.  There’s evidence that familiar voices and human touch can matter to patients with altered consciousness.  You are not wrong to talk to her.  You are not wrong to beg her to fight.  You are not wrong to ask the ICU team to fight for her.  That is love. And love matters in the ICU.  But alongside that love, you also need information. You need advocacy. You need someone holding your hand.  You need someone who understands intensive care inside out, someone who understands the clinical picture to stand with you in that ICU and ask the right questions.  You don’t need to face this alone. As a matter of fact, please do not face this alone. 

If you’re watching this and your loved one is in the ICU right now, call us.  You can contact us at intensivecarehotline.com, call us on one of the numbers on the top of our website, or send us an email to [email protected].  You can also book a free 15-minute consulting call with me when you click the Schedule Appointment button on the website at intensivecarehotline.com. 

Subscribe to my YouTube channel.  Every day, I publish videos answering real questions from real families who are facing real ICU crises.

Hit the notification bell, share the video with your friends and families, and comment. Let me know what you think and what topics you want me to discuss for families in intensive care, so you never miss an episode.  And if this video helped you, gave you information or courage, or gave you a question to ask, please share it with someone else who needs it. That is how we reach the families who are sitting in that waiting room right now, not knowing where to turn.

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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Your FREE Download:  FAQ Mom Is on a Ventilator with Pneumonia Sepsis and Brain Trauma Will She Recover

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.