Podcast: Play in new window | Download
Subscribe: Apple Podcasts | RSS
If your critically ill loved one is deconditioned in intensive care and is failing spontaneous breathing trials, stay tuned! Let me explain to you what to do next.
My name is Patrik Hutzel with another quick tip for families in intensive care.
So, currently we are working with a client who has their sister in ICU, and I’ve got an email from our client that I want to read it out and then answer the question.
“My sister is deconditioned in the ICU. She tires easily on a spontaneous breathing trial (SBT). “That means her sister is ventilated, intubated, and on a breathing tube. In a good intensive care unit, they will try and do a spontaneous breathing trial as quickly as possible to wean a patient off the ventilator and avoid a tracheostomy.
So, then she continues the email.
“The blood pressure tends to go up and staff make sure it doesn’t go above 170 systolic or so. My sister becomes agitated. Her breathing times are erratic, anywhere between 5 minutes and 5 hours. This is when they tend to put her back on the sedative. When she doesn’t do well on the spontaneous breathing trial, she is agitated, and her blood pressure goes up. When should they have started physical therapy? (She had a cardiac arrest approximately Day 6 or 7. She is now Day 20.) Is there any reason why she shouldn’t be getting physical therapy now? What kind of physical therapy is best? Sitting up in a chair and how often? Should I continue to push hard for this? Mind you, she has had many complications, cardiac arrest, pneumonia, UTI (Urinary Tract Infection), blood clots, bleeding in her abdominal area with two large hematomas, etc. How do/have these complications impaired her ability to do spontaneous breathing trials and physical therapy?”
Great questions from our client here and very important questions, and questions that I believe are very relevant to you if you have a family member in intensive care that’s critically ill on a breathing tube and a ventilator.
So, because your sister is deconditioned and that’s when you first came to us, I told you pretty quickly she needs to get off sedation so that they can start physical therapy and that she has a better success rate of weaning off the ventilator and the breathing tube.
Now, the longer someone stays in an induced coma and on sedation and on opiates, the quicker they get deconditioned and the more difficult it gets by the day to wean your critically ill loved one off the ventilator. So, the sooner they can get off sedation, the sooner they can start spontaneous breathing trials, the sooner they can start physical therapy, the higher chances your critically ill loved one will get off the ventilator and the breathing tube and avoid a tracheostomy.
I can’t stress this strong enough that when a patient is in intensive care on a ventilator with a breathing tube, the goal must be to wean this patient off the ventilator and the breathing tube. That must be the goal. Don’t let anyone dissuade you otherwise, there are a few exceptions to the rules. The few exceptions are if it’s a progressive irreversible neuromuscular disease, high spinal injuries.
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 at intensivecarehotline.com. I can confidently say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews. Our client interviews, once again, verify that we have saved lives for their loved ones.
Coming back to our client’s question, so the longer someone stays on sedatives and opiates, the higher chances they get deconditioned fast, and the higher chances are it is getting more and more difficult to wean them off the ventilator successfully. Once again, the goal must be for a critically ill patient in intensive care to wean them off the ventilator and the breathing tube. That must be the goal, full stop. If that can’t be achieved, then the tracheostomy might be the next step.
But in your sister’s case, they haven’t tried anything. They’ve been making excuses and always trying half-heartedly to let her pass the spontaneous breathing trial and always put her back on spontaneous breathing trials and not doing any physical therapy. It’s almost like that trying to set her up to fail to either move her towards the end of life, trying to create the narrative that the end of life is “in your sister’s best interest” or number two, trying to move her towards the tracheostomy and the PEG (Percutaneous Endoscopic Gastrostomy) tube and sending her out into the wild Wild West, into LTAC (Long Term Acute Care).
Now, this is a client in the U.S. that we’re dealing with. The goals of ICUs is are often either to move patients towards end of life as quickly as possible or to move them towards LTAC. Both goals achieve the same end for the ICU, which is to empty their ICU bed, which is their primary goal. So, obviously she becomes agitated when she’s going on the spontaneous breathing trial, which is not unusual. However, they’ve waited far too long and now it’s getting way more difficult.
Now you are asking relevant questions here, should you push hard? Has the cardiac arrest set her back, the pneumonia, the UTI, blood clots etc.? Yes, they are all complicating factors, no questions about that. They probably had to take it a little bit slower compared to other patients that don’t have these complications. Having said all of that, they still can do physical therapy.
So, what do I mean by that? Physical therapy in ICU could be just moving arms, moving legs. Picture this. If your family member is lying in bed for three weeks on end in an induced coma and you’re not even moving joints, you’ll end up with contractions, pressure sores, it’s terrible. It is basic nursing care. It is basic physical therapy that needs to happen from Day 1. We take it for granted that when you’re walking around, you’re moving your joints, you’re moving your arms, and you’re moving your legs whatever, we take it for granted. The minute someone is critically ill in intensive care goes into an induced coma, all movement stops. Think about that.
Therefore, it’s almost like working your family member up towards more at a higher and higher exercise tolerance level. It is in the beginning, just moving arms, moving legs. That’s all it is in the beginning, but you got to start somewhere, and you mustn’t underestimate how quickly your family member might be conditioned. You mustn’t underestimate that at all.
Every good ICU that I worked at, we were doing physical therapy, or the physical therapists were doing physical therapy right from the start, right from the get-go, every day religiously, and after-hours, nurses can do physical therapy too; moving arms, moving legs, moving joints, not rocket science. So, your sister needs to do more and more exercise. They need to wean her off sedation urgently because otherwise, she’ll end up with the tracheostomy and you don’t want that.
We have helped hundreds of members and clients over the years here at intensivecarehotline.com with our consulting and advocacy. Like I said, have a look at our testimonial section, and have a look at our intensivecarehotline.com podcast section where we have testimonials from members and clients.
That’s why we created the 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 eBooks and 21 videos that I have personally written and recorded. All of the access to me and my team, and the eBooks and the videos will help you to make informed decisions, have peace of mind, control, power, and influence so that your loved one will get best care and treatment always.
I also do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and directly. I handhold you through this once in a lifetime situation that you simply can’t afford to get wrong. 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.
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 if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.
All of that you get 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] 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 have from this video.
I also do a weekly YouTube live where I answer your questions live on the show and you will get notification for the YouTube live if you are a subscriber of my YouTube channel, or if you are a subscriber of our intensivecarehotline.com email newsletter.
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.