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

So, when our subscribers opt-in for their free instant impact report on our website intensivecarehotline.com, or when they opt-in for their free mini report and mini video series, we ask them,  what’s their biggest frustration? And that’s where we get a lot of our questions and answers from.

So here is one subscriber that said, that their biggest frustration is that, “My husband is in intensive care. He’s on a ventilator. The intensive care team says he can breathe for himself, but they won’t take him off sedation and off the ventilator”. Even though that’s what they’re saying, “He can breathe by himself and they’re not letting him wake up fully and not take all sedation off. So, what should I be doing?” So, it’s quite a common question we’re getting in.

And the first answer to this question is that 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. But let’s break this very general question down so that you can understand what’s most likely happening in a situation like that. As I said, we’re getting very similar descriptions of our subscriber’s frustration.

So when someone is in an induced coma, slowly waking up after they’re being ventilated in an induced coma, so the intensive care team then will do some breathing trials on CPAP (Continuous Positive Airway Pressure), pressure support, and see how a patient is coping. So they take them gradually off sedation, and then they should breathe up in the ideal world. Their neurological assessment is being done. Is their brain intact? Can they follow commands? And it’s often a two steps forward, one step back process.

So when the intensive care team is telling our subscriber here that he can breathe by himself, but they won’t take him off ventilation, it means that he’s probably breathing in pressure support or in CPAP and his tidal volumes are potentially too low. Maybe his brain isn’t fully functioning yet. Maybe he’s still too drowsy. Maybe he’s not obeying commands yet. Maybe the arterial blood gases  are not at a level where he can be extubated, i.e. the breathing tube can be removed. Maybe he doesn’t have a cough. Maybe he’s getting agitated when he’s waking up. So again, it’s often a two step forward, one step back process before someone can be extubated and before they can be fully taken off sedation and opiates.

Also when someone is taking off sedation, opiates, especially if they’ve been on midazolam or Versed for quite some time, or if they’ve been on morphine or fentanyl for quite some time, they may go through a withdrawal because benzodiazepines such as midazolam or Versed or opiates such as morphine or fentanyl are highly addictive. So when patients wake up, they may also go through a withdrawal process, which may stop them to breathe fully so that they’re fully ready for extubation. When you extubate a patient, take the breathing tube out, you have a limited time window. And you need to choose that time window at the right time. So you’re not extubating. And then you need to re-intubate within a few hours or within a couple of days. Now, what you also need to ask is, are they doing everything beyond the shadow of a doubt to get him off the ventilator?

Again, at the moment, you probably don’t know what you’re looking for and you don’t know what questions to ask. So I’ve given you some insights here, but if you have a family member in a similar situation, go to intensivecarehotline.com, contact us on one of the numbers at the top of our website, or send us an email to [email protected].

Also, have a look at our membership for families in intensive care, at intensivecaresupport.org.

We also offer medical record reviews for families in intensive care or for patients in intensive care or after intensive care. If you want to find out whether there’s been medical negligence or any foul play, we can help you with all of that.

Now, give this video a thumbs up, share it with your friends and families, and subscribe to my YouTube channel for regular updates for families in intensive care, including a weekly livestream. Click the notification bell and comment below what you want to see next, or what questions that you have.

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

Thank you.