My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

Here at intensivecarehotline.com, 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.

If your dad is in ICU right now on a ventilator with a tracheostomy, and the doctors are making medication changes that you don’t fully understand, and you’re wondering, “Am I asking the right questions? Am I doing enough?” this video today is for you.

I have a question today from Leo. Before I read out Leo’s question, you might be wondering what makes me qualified to answer questions for families in intensive care.

I’m a critical care nurse by background, having worked in critical care nursing for over 25 years in three different countries, where I have worked as a nurse manager for over five years in intensive care.

I have 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 for our clients in intensive care. You can verify that in our testimonial section at intensivecarehotline.com, and you can verify it in our podcast section, where we have done client interviews on our website.at intensive care hotline.com

I’m also the founder and managing director of Intensive Care at Home, where we send intensive care nurses into the home for long-term ventilation with a tracheostomy. You can find more information at intensivecareathome.com.

So, let me now read out Leo’s question.

Leo writes:

“Hi Patrik,

The doctor just finished rounding. I passed along your information to Dr. Gautam.The doctor changed some of my father’s medication. Levophed was replaced with phenylephrine, sodium chloride and Protonix were added to the profile once again.  She’s also going to put a muscle relaxer PRN (as needed) on his profile.

Interventional radiology was consulted again, as well as cardiology. I inquired about the ultrasound of the abdomen, and they said they’re going to leave that to interventional radiology.  The nurse found an eyelash in my father’s eye and is hoping that it will help alleviate the redness in his right eye.

Today, brownish secretions are coming out of his tracheostomy site, so they’re just going to watch and monitor.  Are there any other things I need to suggest to the doctors and nurses to provide and promote healing and comfort for my dad?

To you and your team, thank you so much.

From Leo.”

Leo has been one of our members because we have a membership for families of critically ill patients in intensive care. We are conversing with Leo quite frequently as part of his dad’s situation.

Let me walk you through what’s happening with Leo’s dad because each of these clinical changes’ matters.

1. The vasopressor change

First, the vasopressor change.  Levophed, which is norepinephrine or noradrenaline, is the most commonly used blood pressure medication in ICU. It has been replaced with phenylephrine. Both medications keep blood pressure up, but they work differently.  Phenylephrine is a pure vasoconstrictor.  The team may be switching because of heart rate concerns or because the vasopressor requirement has reduced.  Either way, this tells us that his father is still hemodynamically fragile.

2. Protonix has been added back

Second, Protonix is back on. This is good because it protects the stomach lining. On vasopressors and during critical illness, gut perfusion is compromised.  Protonix prevents stress ulcers.  Protonix is also known as pantoprazole, and Leo’s dad had gastric bleeds before.

3. A muscle relaxer PRN has been added

Third, a muscle relaxer PRN has been added, which is significant.  In ICU, muscle relaxers are often used to prevent a patient from fighting the ventilator, which we call patient-ventilator desynchrony.  PRN means as needed, but if it’s being used, it means his father’s ventilation is not smooth.  Watch this closely.

4. Brownish secretions from the tracheostomy

Fourth, brownish secretions from the tracheostomy should not be dismissed. These brownish or blood-tinged secretions can mean old blood, an infection, or tracheal irritation. A sputum culture needs to be sent.  The tracheostomy site needs daily inspection.

5. Interventional radiology and cardiology have been reconsulted

Fifth, interventional radiology and cardiology have both been reconsulted.  That tells me there is a complex, multisystem problem being managed.  The abdominal ultrasound being deferred to interventional radiology suggests they may be planning an intervention, not just a scan.

6. The eyelash in Leo’s dad’s eye

And finally, the eyelash in Leo’s dad’s eye.  It sounds minor, but eye care in ICU patients is critical.  Sedated patients can’t close their eyes fully, and corneal injury can happen very fast. Imagine you’re in bed in ICU. You can’t move, and you can’t even wipe your eye. Eye care is very important.

Questions You Should Ask the ICU Doctors and Nurses

Now, let’s look, Leo, at what questions you should be asking.

Here are the questions I want Leo and you to take to the bedside right now if you are in a similar situation to Leo.

Questions about the vasopressor change

First question: Why phenylephrine instead of Levophed?

• What is the MAP (mean arterial pressure) target?
• It’s usually above 65 to maintain kidney and other vital organ perfusion.
• What does the cardiology team say about his heart function?
• When do we plan to start weaning the vasopressors?

Questions about the tracheostomy secretions

• Has a sputum culture been sent?
• Is the tracheostomy site being formally inspected daily?
• Is there a protocol for tracheostomy care?
• What is the suctioning technique, and is it causing any trauma?
• Does my dad have an inner cannula, and is it being changed regularly?
• Is my dad having regular nebulizers?

Questions about the muscle relaxer

• What are the clinical triggers for using it?
• Is my father adequately sedated and pain-free before it’s given?
• Is there a daily sedation wake-up trial happening?

Questions about interventional radiology and cardiology

• What specifically is interventional radiology being asked to evaluate or do?
• Has an echocardiogram or ultrasound been done, and what did it show?
• When will the abdominal assessment happen?

Questions about eye care

• Is there a formal eye care protocol?
• Does an ophthalmologist need to be involved?

Questions about nutrition and long-term ventilation

And the big questions:

• Is my father receiving adequate nutrition?
• What is his current trajectory?
• If he cannot be weaned off the ventilator, what are the long-term options?

Why You Need Access to All of Your Dad’s Medical Records

Next, why you need access to all your dad’s medical records, Leo.

I want to say this very clearly, Leo: You need to get access to all your father’s medical records, not just the daily update from the doctor on the ward round.

You need all of it:

• Nursing notes.
• Doctors’ notes.
• Medication charts.
• Laboratory results.
• Investigation results.
• Specialist letters.
• Ventilator parameters.
• Vital sign parameters.
• Fluid balance charts.

Leave no stone unturned.  Why?  Because what you’ll hear in a 10-minute ward round is a fraction of what is actually happening.  When I work with families here at intensivecarehotline.com, the first thing I do with my team is review the medical records, because that is where the full picture lives.

With the medical records, we can track trends.  We can see if kidney function is getting better or worse.  We can see if the ventilator requirements are increasing.  We can identify gaps, tests that were ordered and never resulted, and referrals that never happened.  If there’s ever a concern about the quality of care, or if you need a second opinion, those records are absolutely essential.  You have the right to request them.  Do it now.

How Can We Help? We Can Consult with the ICU Team

So, how can we help?  We can consult with the ICU team.  One of the most impactful things we do at intensivecarehotline.com is participate directly in consulting calls with the ICU team, with you on the line.

Here’s what that looks like.

Ideally, we review the medical records before the call. We prepare the questions, and we are on the call with you when you speak to the doctor.  We question, we challenge, we advocate, and we translate the medical language into plain English so you can understand and make informed decisions.  You don’t have to sit across from the doctor and feel like you’re the only person in the room who doesn’t know what’s going on.  You can have a 25-year ICU veteran sitting beside you, metaphorically speaking, asking the hard questions.

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

What If Dad Can’t Be Weaned Off the Ventilator and the Tracheostomy?

Next, what if Dad can’t be weaned off the ventilator and the tracheostomy?  I want to talk about something that many families are afraid to even think about. What happens if your dad can’t come off the ventilator.  I want you to know that this is not the end.  It is not a death sentence, and it doesn’t mean your father has to spend the rest of his life in an ICU bed or a nursing home that is not equipped to care for him.

At Intensive Care at Home, we specialize in helping ventilator-dependent patients go home.  Whether they need invasive ventilation through a tracheostomy 24 hours a day, non-invasive ventilation with BiPAP or CPAP, or high-level nursing care with a tracheostomy without ventilation, we can support them at home with 24-hour critical care nurses, similar to an intensive care unit, predictably and permanently.

We have supported patients with motor neuron disease, spinal cord injuries, Guillain-Barré syndrome, chronic obstructive pulmonary disease (COPD), and many other conditions that have left patients requiring long-term ventilation and tracheostomy.

We are National Disability Insurance Scheme (NDIS) registered and we are ISO 9001 audited and accredited.  We have over 150 critical care registered nurses working all across Australia, in all states and territories, in all metropolitan areas, and in all regional and rural areas.

I know some of you watching are in the US, Canada, and the UK, and you’re wondering, “Hey, is Intensive Care at Home available for me as well?”  I want you to reach out to us because we have helped families in those countries as well. While we are mainly in Australia right now, we have helped families in the US, Canada, and the UK.  Please reach out to us at intensivecareathome.com as well.

Back to Leo. If the goal of care shifts for your dad, and your family decides that quality of life and comfort at home are the priority, we can also support palliative ventilator-dependent patients at home with compassion, dignity, and privacy.

Once again, go to intensivecareathome.com for more information.

A Personal Message to Leo and Other ICU Families

Leo, I want to say something to you directly.  What you’re doing for your dad is extraordinary. Showing up, asking questions, and reaching out for help—your presence at that bedside matters more than you can imagine.

To everyone watching this, if your loved one is in ICU and you feel lost, overwhelmed, or like you are not getting the full picture, reach out to us.  That is exactly why we are here. Go to intensivecarehotline.com, call us on one of the numbers at the top of our website, or send us an email at [email protected].

You can also book a 15-minute consultation call with me on the website. Schedule your appointment now.  We will review the medical records, prepare the questions, and be with you through this every step of the way.

If you found this video helpful, please subscribe, hit the notification bell, and share it with any family who can benefit from this video and who has a loved one in ICU.  Comment on what you think about Leo’s dad’s situation.  Help other families by sharing this.

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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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.