Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

If you want to know how to help your loved one when they’re not passing spontaneous breathing trials with a tracheostomy, stay tuned! I’ve got news for you.

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

So, currently we’re working with a client where their family member is in intensive care. Initially, they were told that their family member won’t survive the ICU stay after cardiac arrest and after a stroke. They were told that even if they were to survive that they won’t have any “quality of life,” and I’d say, perceived quality of life because quality of life is just that it’s a perception, it’s not reality. It’s all in someone’s mind what quality of life is acceptable for them in any case. The doom and gloom scenario and the negativity from the intensive care team was put on the family right from the start. The family kept advocating for their loved one, and here we are a few weeks later, their family member now has a tracheostomy and is slowly waking up.

Let me read out an email from our client here.

“The nurse said my family member didn’t sleep most of the night. Same the next night too. My family member did nap a bit and then smiled quite a bit the rest of the day. I kidded her – pulled my finger and she laughed and was able to slightly grip it. Just a couple of days ago, her hands were limp. As you can see in the picture, she brought her arm even up and put her thumb and finger in pinch motion. She was doing this with both hands.”

Now, once again, this is someone where the intensive care team said she wouldn’t survive, and if she would survive, she won’t have any quality of life. This is someone that’s now coming out of a prolonged induced coma and is clearly showing signs of waking up. So again, one has to question the clinical judgment of an intensive care team. 

Also, here is another important aspect of this. The nurse is saying she’s not sleeping most of the night, that is a big issue for patients that are in prolonged induced coma. When they come out of the induced coma, they’re having a disturbed day and night rhythm. That’s why you need to minimize the time spent in an induced coma.

For this particular patient, they could have minimized the time spent in an induced coma if they (a) would have tried to wean her right from the get-go or if they (b) would have moved towards the tracheostomy quicker. There were huge delays on both ends, maybe this lady didn’t even need a tracheostomy in the first place. They could have weaned her off the ventilator, but they never pushed that because they were always telling the family she should just die. You have to question everything.

So, the email continues.

“Sputum culture was taken for query pneumonia. She was coughing some sputum, not much coming out when suctioned. White cell count is 17,000, up from 13,000, told likely from the tracheostomy procedure. Also doing blood culture. Chest X-ray looked good, unchanged. She changed dressing and wound healing well.”

So, this is the problem. The longer someone is ventilated in intensive care, intubated with or then moves towards a tracheostomy, the higher chances they end up with a ventilator-associated pneumonia. That’s why it’s so important that you keep pushing towards weaning your loved one off the ventilator as quickly as possible to maximize chances to get them off the ventilator as quickly as possible. That’s why you need a second opinion right from the get-go. You are in a once in a lifetime situation that you can’t afford to get wrong.

So, the email continues.

“She was only able to do a spontaneous breathing trial for about 45 minutes. They did sit her up in a cardiac chair today from 8:10 to 9:30 a.m.” Well, that’s a start but they should have done that weeks ago, why only now? She should be out of bed and mobilized by now. So those huge delays continue to contribute to prolonged ventilation, and it’s simply not good enough.

So, then email continues.

“The neurologist was in. The neurologist said my family member had improved a little. Didn’t feel her recovery was good. Said she would expect to see more by now. There were spikes on last night’s EEG (Electroencephalogram). Said she can’t access the brain until my family member starts following more commands.

She’s getting hydrocodone for pain. No sedatives. RN said she’s hemodynamically stable.

For the blood pressure, on metoprolol every 6 hours, 50 mg, short acting. Hydralazine, 50mg every 8 hours. Losartan, 50mg daily. No aspirin. SubQ heparin 5000 units to belly.

I don’t know how my family member can do a long breathing trial when she hasn’t been sleeping much over the past two nights.”

I agree with that. She needs to get into a good day and night rhythm to be awake during the day so that she can tolerate the spontaneous breathing trials. So how to counteract that? Well, one way to get her into a good day and night rhythm is really doing some physical therapy, mobilizing her during the day, doing spontaneous breathing trials during the day so she’s actually getting tired during the day so that she can sleep at night. Common sense. 

I’m always gobsmacked by how families do not think common sense. ICU teams often don’t think common sense because they’re trying to sell you and tell you what is in the best interest of your family member to die, that’s not common sense as far as I’m concerned. Always think common sense, always. Always bring it back to common sense. Don’t let anyone dissuade you not to use common sense.

Now, think about this. If you exercise during the day, can you sleep at night? The answer is most likely yes. It’s the same in this situation. She’s got a disturbed day and night rhythm from the induced coma. Let’s move towards mobilization, physical therapy, spontaneous breathing trials during the day so she’s tired and can sleep at night. It doesn’t need any medications. What she might be able to use is vitamin D and melatonin, that might help with sleep and those are natural products, so you can maybe use that. But always bring it back to common sense.

Here’s another tip. In a good ICU, your sister will have a shower at least once a week, every second day in a good ICU. Now, I can tell you, that will also help with day and night rhythm. Imagine how refreshed your sister feels if she has a shower. A good ICU will facilitate that for her. Once again, always bring it back to common sense.

Now, talking about spontaneous breathing trials, don’t be discouraged if she can only pass a spontaneous breathing trial for 30 minutes, that’s the starting point. Don’t expect any miracles. She needs to be built up towards breathing spontaneously gradually. Maybe she can tolerate 30 minutes today, maybe 40 minutes tomorrow, maybe 45 minutes the day after, maybe an hour the day after, it will go in stages. Your sister is so deconditioned right now that she can probably only build up her tolerance towards breathing spontaneously, slowly and gradually. Don’t be discouraged but keep moving towards the goal.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com.  I can confidently say that we have saved many lives as part of our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com and you can read what our clients say there in our testimonial section, or you can watch our intensivecarehotline.com podcast where we’ve done client interviews who will verify on the podcast that we saved lives for their family members. We even have one of our ex-patients on a podcast where the ICU team said, “Well, he’s not going to survive.” He’s actually on a podcast telling his survival story. So, go to intensivecarehotline.com, check out our podcast section there. 

We have helped hundreds of members and clients over the years to improve their lives instantly, saving lives. That’s why we created a membership for families of critically ill patients, and you could become a member there 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, 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 access to 21 eBooks and 21 videos that I’ve personally written and recorded that will help you to make informed decisions, get peace of mind, control, power, and influence so that your loved one gets best care and treatment always.

I also do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, Skype, whichever medium works best for you. 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. I also talk to doctors and nurses directly. When I talk to doctors and nurses directly, I ask 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. By asking the right questions, I am able to hold doctors and nurses to account.

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 in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

All of that you get at the intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected] 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, and comment below what you want to see next, what questions and insights are from this video. 

I also do a weekly YouTube live where I answer your questions live on a show and you will get notification for the YouTube live if you are a subscriber to my YouTube channel or if you are a subscriber to my email newsletter at the intensivecarehotline.com. Share the video with your friends and families so that we can help as many families as possible.

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.