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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So today’s tip is about an email from a reader who asks, “My wife is in intensive care and she’s just coming out of the induced coma. She’s on a ventilator with a breathing tube, and she seems to be mouthing words, and I think she’s saying, help me and get me out of here, but she’s not quite ready to get off the ventilator yet. What should I do?” And I can only imagine how frustrating this would be for our reader to see his wife in a situation like that. You can see when patients come out of the induced coma that they can be very frustrated, especially if extubation and weaning off the ventilator is not imminent, and it might take a few more days.

There’s a fine line between waking someone up, having them tolerant to the breathing tube in their mouth, and getting them to breathe more and more spontaneously, getting them to wake up. When patients do come out of an induced coma, they often have no recollection of what’s happened, why they are in an induced coma. They often have no recollection of what’s happened, and they’re waking up in an ICU, in a strange environment, strangers around them, and they’re just having the sedatives and the opiates weaning off. And that can be very, very challenging. So what should you be doing in a situation like this?

Well, one thing you should be doing is that you and your family should be there for your wife. You can go there, hold her hand, talk to her, reassuring her. But the ICU team should also reassure her. The good thing is she seems to want to express herself, which is really important. And that’s a good sign.

And now the next step is, can she breathe spontaneously? Can she breathe to the point where she can be extubated? Can she do things like holding your hands, squeezing your hand when you are asking her to do so? Can she blink her eyes when you ask her to? Can she poke out her tongue? Does she have a good, strong cough? Because she needs to be able to clear her airway once the breathing tube has been removed.

Next question is, what ventilator settings is she on? Is she still in an SIMV (synchronized intermittent mandatory ventilation) mode or a CMV (continuous mandatory ventilation) mode where she gets mandatory breaths from the ventilator every minute? Or is she now at the point where she can breathe spontaneously in CPAP (continuous positive airway pressure) or in pressure support? And if she can breathe in CPAP or pressure support, what is her pressure support like? Is it less than 10? What are her tidal volumes, the volumes she’s breathing? What are her arterial blood gases like? Are PO2 (partial pressure of oxygen) and PCO2 (partial pressure of carbon dioxide) within normal range? And is her breathing rate normal? Is it a normal breathing rate between, let’s just say 10 to 30 breaths per minute? And again, a tidal volume that’s adequate for her weight? Once these boxes are ticked, then the breathing tube can come out.

Again, it is extremely frustrating for patients when they come out of the induced coma. They realize something has happened, they can’t talk. Another thing that you can do is give your wife a pen and paper and see whether she can write down what she would like. If she can’t write, ask them. Ask the doctors and nurses to give her a letter board where she can point with her finger towards the letters and, get the words together that she wants to say. So there are ways to communicate, but obviously it is important that she can have the work up to have the breathing tube removed. That also includes physical therapy, physiotherapy, breathing exercises, coughing exercises, mobilization, ideally get her out of bed, get her breathing muscles strong so that she can breathe independently and have the breathing tube removed as quickly as possible. And it’s also important that she can stay off the sedation and the opiates. It’s also important that your wife stays calm because if she’s not calm and cooperative then often ICU teams, re-sedate patients, which sets them back in their way towards extubation.

The longer someone is in an induced coma deconditioning is real, muscle wastage is real. So, it’s important that your wife stays calm and cooperative so that the breathing tube can come out when she’s ready. And it sounds to me like she’s very close to be ready. I hope that helps.

Now, if you have a loved one in intensive care and you need help, please contact us at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There you have access to me and my team 24 hours a day in a membership area and via email and we answer all questions intensive care related.

Also, if you need a medical record review for your loved one in intensive care, we can do that for you in real time while your loved one is in intensive care by you getting access to the medical records, which is your right to get access to the medical records. We also review medical records after intensive care, especially if you need closure, if you have unanswered questions or if you are suspecting negligence. But we strongly advise and recommend that you ask us to review medical records in real time so that you can have a second opinion in real time, and that you have someone breaking down the medical jargon to you in real time.

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 questions and insights you have and what you want to see next.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I’ll talk to you in a few days.

Take care for now.