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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 that we had from a reader who says, “My mom is in ICU, and she’s starting to get stronger and more aware, but the doctors used her sedation and said, for her swelling to go down. But the last CT (Computed Tomography) scan was on August 8, and it’s been a week and 2 days, and she’s breathing on her own. But she does have COPD (Chronic Obstructive Pulmonary Disease). And they’re saying, they don’t want to take the tube out yet and want to do a tracheostomy, but not giving her a chance to see if she can breathe without it. What do I do to give her body time to heal without getting a tracheostomy?” What a great question.

So yes, they probably use sedation to heal your mom. You didn’t actually say why she is in ICU. She’s probably got some issues from the COPD. Maybe she had a pneumonia, maybe she had COVID, you didn’t specify. But the reality is that, she’s not strong enough and they want to do a tracheostomy and they’re not giving her a chance to see if she can breathe without it.

So, it’s quite logical what needs to happen next. Okay, if your mom is awake and she can obey commands, if she can breathe on a pressure support or on a CPAP (Continuous Positive Airway Pressure) mode with a PEEP (Positive End-Expiratory Pressure) of 5, with pressure support less than 10, with tidal volumes that are adequate for her weight and body index. If her respiratory rate is normal, which means breathing rate should be between 8 breaths per minute and roughly 25 breaths per minute. Again, if tidal volumes are fine, if arterial blood gases are fine, ie., PO2 (Partial Pressure of Oxygen) should be above 70 millimeter per mercury and PCO2 (Partial Pressure of Carbon Dioxide) should be between 35 and 45 millimeter per mercury, then she should be ready for extubation.

Now, your mom has COPD. Maybe her blood gas shows that her CO2 is very high. And if her CO2  (Carbon Dioxide) is very high, maybe they do need to adjust the settings of the ventilator. But also it’s important to understand what is her baseline CO2.

So, someone with COPD or asthma might have a high baseline CO2 ie., they’re used to a high CO2 level. Maybe her baseline CO2 is 50 and she’s functioning perfectly normal with that. So those are the questions you should be asking. As I said, there’s a logical approach to this and not an emotional approach. It’s really about getting all the clinical parameters and ticking the boxes.

And that’s why I keep saying 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 this becomes quite evident from this email here, because families in intensive care don’t know the steps that need to be taken when it comes to ventilation, extubation, should they have a tracheostomy? Should they not have a tracheostomy?

And then the next question is, God forbid if she does need a tracheostomy, to what end will she be able to get extubated? Or does she need a tracheostomy for a long time to come? Does she need to go home with Intensive Care at Home? You can check out intensivecareathome.com for that. So, I hope that helps.

That is my quick tip for today.

If you have a loved one in intensive care, go to 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 that answers your questions about intensive care, if you have a loved one in intensive care and you have access to me in a membership area and via email.

Also, if you need a medical record review, go and contact us as well. We can help you reviewing medical records while your loved one is in intensive care or after intensive care, especially if you suspect any negligence or the likes.

Share this video with your friends and family. Subscribe to my YouTube channel for regular updates for families in intensive care and Intensive Care at Home. Click the like button, click the notification bell and comment below what you want to see next, or what questions and insights you have from this video.

Thanks for watching.

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