My name is Patrik Hutzel from intensivecareathome.com, and this is another quick tip for families in intensive care. Here at intensivecareathome.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, even if you’re not a doctor or a nurse in intensive care.

I’m the founder of Intensivecareathome.com, and I have been working in critical care nursing for over 25 years in three different countries, where I have been consulting and advocating for families in intensive care all over the world since 2013. I can confidently say that we have saved many lives for our clients and their families in intensive care. You can verify that on our testimonial section at Intensivecareathome.com and also on our podcast section at Intensivecareathome.com, where we have done client interviews.

Today, I’m responding to a message from Chayo. If you’re watching this, I want you to know this video is for you, because what Chayo is going through is something I hear about every single week: a loved one in ICU getting worse instead of getting better, and a family that feels completely alone.  Stay with me through this entire video, because by the end, you will have a clear understanding of what is happening clinically, what questions to ask, and what options you actually have.

Chayo writes:

“My mom has been in ICU, in and out, for more than 39 days. First, she had pneumonia, then they treated her and transferred her to recuperate, but then one of the veins in her nose started bleeding very badly, probably because of the feeding tube, so they cauterized it. Then they transferred her to recover and then brought her back to the ICU because she couldn’t breathe. Her CO2 (carbon dioxide) was too high, and her heart rate was really high. Now they’re saying something about her liver failing. Instead of improving, she’s getting worse. I’m the only adult in my family who can handle this. I don’t know what to do. I need help.”

Chayo, that message really broke my heart, and I know exactly how you feel. Let me explain step by step what is happening to your mother and what you can do about it.

Nasal bleeding and the feeding tube — what really happened.   Chayo mentions a vein in her mother’s nose bleeding very badly. The most likely cause is a nasogastric tube, a feeding tube inserted through the nose. These tubes can cause trauma to the nasal lining, especially in patients who are critically ill, possibly on blood thinners, or who have clotting problems — which is probably secondary to the liver failing. The team cauterized, or burned, the bleeding blood vessel. That is standard practice.

But here’s the important clinical question the team should be answering: why did she bleed so badly? Is there an underlying clotting problem? Is the liver already struggling to produce clotting factors? Because if the answer is yes, that changes everything about how serious the situation is. Families are rarely told about these connections. That is why I’m here.

CO2 retention and breathing failure — the core problem.

When Chayo’s mother came back to ICU, her CO2, or carbon dioxide, was too high. In medical terms, this is called hypercapnia, and it tells us the lungs are not doing their job of removing carbon dioxide from the blood. The elevated heart rate, the tachycardia, is the body’s alarm system — the heart is working harder and harder to compensate for what the lungs cannot do.

This can happen because the pneumonia has not fully resolved, or a new infection has developed. The breathing muscles are exhausted, especially in a patient who has been critically ill for 39 days.

There may also be a secondary complication such as fluid in the lungs, a pulmonary embolism, or worsening respiratory muscle weakness.

At this point, the team should be seriously considering: does this patient need a tracheostomy? Does she need long-term ventilation? And if she does, what does that look like for her and for her family?

Liver involvement — when multiple organs start failing

This is the part of Chayo’s message that concerns me the most. Now the liver is involved. In a patient who has already been in ICU for 39 days, liver dysfunction can occur for several reasons: reduced oxygen delivery during periods of low blood pressure, sepsis from ongoing or new infection, medication toxicity from prolonged ICU drug use, or clotting factor failure, which directly links back to that nasal bleed.

When the lungs, the heart, and now the liver are all under stress, the ICU team may begin using words like “multi-organ dysfunction,” “goals of care,” or “comfort measures.” Chayo, if you hear these words, do not let the team make decisions without you. You have rights, you have a voice, and we can help you use it.

Treatment options — what should the team be doing.  Let me walk you through the realistic treatment options for a patient in Chayo’s mother’s situation:

• Optimize the ventilator — adjust settings to improve CO2 removal. Identify and treat the cause of liver dysfunction — sepsis, reduced perfusion, and medications.  Review nutritional support — with the nasogastric tube possibly out, there needs to be a plan.  Consider a tracheostomy — if she’s not being weaned from the ventilator, a tracheostomy is safer and more comfortable for the long-term.

Direct and honest goals-of-care discussion with the family — what are the realistic outcomes, what does the patient want?  Consider home ventilation with Intensive Care at Home — if she stabilizes but cannot be fully weaned, going home on a ventilator is possible. I’ll come to that in a minute.

Get all the medical records  — this is non-negotiable. I’m going to say this very clearly: if your loved one is in ICU and you do not have the medical records in your hands, get them today. In the United States, in Australia, in the UK, in any Western country, you have a legal right to access medical records. You are entitled to nursing notes, medical notes, lab results, imaging such as chest X-rays, CT (Computed Tomography) scans, MRI (Magnetic Resonance Imaging) scans, ventilation charts, medication records, vital signs, and fluid balance charts. Get everything.  Why? Because those records are the foundation of every conversation, every decision, every advocacy effort.

When our team at intensivecareathome.com  speaks with an ICU team on your behalf, we do it from a position of clinical knowledge and advocacy, because we have read the records, we understand what’s happening, and we ask the right questions.  Request the medical records in writing today. If the hospital is slow, escalate to hospital executives.

How intensivecareathome.com can help you right now.  Here at intensivecareathome.com — that is www.intensivecareathome.com — my team and I work with ICU families in the United States, Canada, Australia, the UK, India, and all around the world. We are not a call center; we are experienced critical care nurses, and we do real-world, real-time clinical advocacy.

We can review your loved one’s medical records.  We can join a family meeting, either in person, on the phone, or via video. We speak directly with ICU teams. We explain everything to you in plain, simple language, and we can advocate loudly but professionally for the best possible care and outcomes.

Now, let’s look at home ventilation with Intensive Care at Home getting your loved one out of ICU for good.  If Chayo’s mother stabilizes but cannot be fully weaned from the ventilator, the goal should be getting her home, not keeping her in ICU indefinitely. Intensive Care at Home, and you can find more information at www.intensivecareathome.com.

With Intensive Care at Home, we are the only third-party accredited specialist home nursing provider for ventilator-dependent patients, adults and children in Australia right now.  We can support patients on invasive ventilation with tracheostomy, non-invasive ventilation like BiPAP, CPAP, patients needing complex nursing care, and even patients in palliative care who want to die at home with dignity. We also help families not only in Australia, but in the US, the UK, Canada, and all over the world, really, because we help them wherever we can.

But if you’re in Australia right now, and your loved one is ventilator-dependent in ICU or medically complex, go to intensivecareathome.com and find out if we can help you bring them home. Call us at one of the numbers at the top of our website. If you’re international, call us on one of the international numbers — we’ll help you one way or another.

So, here’s your action plan right now, Chayo:

Step one: Request all medical records from the ICU and the hospital, in writing, and do that today.

Step two: Book a consulting call with me at intensivecareathome.com.

Step three: Ask for a formal family meeting with the ICU team, bring your questions in writing, and bring me along there, because otherwise you won’t stand a chance.

Number four: Ask directly: what is the treatment plan, what are the realistic goals, what happens if my mom doesn’t improve?

Step five: Ask about a tracheostomy if she’s not being weaned from the ventilator. know that home is still possible — contact www.intensivecareathome.com if you need help.

Chayo, you are your mother’s voice. You are doing the right thing by reaching out and asking for help. Do not and never give up.

If this video helped you, please subscribe to this channel. Every week I publish new videos answering real questions from real ICU families, just like Chayo’s. Hit the notification bell so you never miss out.

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 intensivecareathome.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 intensivecareathome.com and you can verify it on our intensivecareathome.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 intensivecareathome.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 intensivecareathome.com. Call us on one of the numbers at the top of our website or simply send us an email to support at intensivecareathome.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.

I also do a weekly YouTube live

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Thank you so much for watching.

This is Patrik Hutzel from intensivecareathome.com, and I will talk to you in a few days.

Take care for now.