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YOUR INTENSIVE CARE HOTLINE - Quick Tip for Families in ICU: The ICU Consultant Refuses to do a Spontaneous Breathing Trial for my Mom on FiO2 (Fraction of inspired Oxygen) 21% & PEEP (Positive End Expiratory Pressure) 5, Help!

/ Patrik Hutzel - Critical Care Nurse Consultant / No Comments

Quick Tip for Families in ICU: The ICU Consultant Refuses to do a Spontaneous Breathing Trial for my Mom on FiO2 (Fraction of inspired Oxygen) 21% & PEEP (Positive End Expiratory Pressure) 5, Help!

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

So, today I want to answer a question from a reader, and the reader says, “The intensivist in ICU, refuses to try a spontaneous breathing trial with my mom. She’s on FiO2 21% and PEEP of 5.”

Well, that is a great question and I’m so glad you’re asking it so I can help you shed light on a situation like that. You’re absolutely right. The intensivist should do a spontaneous breathing trial. I don’t know why they’re not, but I’m so glad you’re doing your research because obviously you must have done some research on our website and you’ve must have read enough case studies. You must have watched enough videos to piece the puzzle together. That’s exactly our purpose here at intensivecarehotline.com, helping families in intensive care to get educated, to ask the right questions, hold intensive care teams accountable.

You’re not sharing where your location, but, one reason that they may not want to do a spontaneous breathing trial, is simply, if you are in the U.S. they probably want to send your mom out to LTAC (long-term acute care) and let them deal with the weaning. And that’s just inappropriate because LTACs are dangerous places. Patients need to be weaned off the ventilator in intensive care where all the expertise is, and you should be asking the intensivist why he’s not doing a spontaneous breathing trial.

Now, I have written an article and made a video a couple of years ago about “How to Wean a Critically Ill Patient off the Ventilator and the Breathing Tube?”. And I will link towards that article and video below this video so you can actually walk through it step by step. You can actually see whether the intensive care team is doing what they’re supposed to be doing, every day on a ventilator could damage a patient in the long run.

So getting your mom off that ventilator on those low settings is really critical. Especially if she’s off sedation, if she’s off inotropes and vasopressors, if there’s nothing stopping her from sitting up, what’s holding her back? Keep asking the right question. So I’m so glad you are asking that question. I hope other families can benefit from this video too, that when settings are low, FiO2 means oxygen delivered on the ventilator at 21%. That’s the lowest it can be. Room air. The air that you and I are breathing is 21%. So it can’t go any lower than that. PEEP of 5 can’t go any lower than that either. PEEP of 5 is the minimum PEEP in ICU on a ventilator.

So again, what else is missing here? What’s missing here is, “Is she already on a spontaneous breathing trial?” Probably not by the sounds of things. So what they need to do is they need to change her to CPAP (Continuous positive airway pressure) or pressure support mode and then start this spontaneous breathing trial. Do some arterial blood gases to see whether oxygen perfusion and CO2 (carbon dioxide) is adequate. If she’s awake, if she’s obeying commands, take the breathing tube out. And if she has a tracheostomy you haven’t shared that. If she has a tracheostomy, again, if she can breathe spontaneously, get her on the tracheostomy mask, and if she can breathe there independently, eventually take off the ventilator completely and then work on decannulation. Removing the tracheostomy.

So 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 and we answer all questions, intensive care related in a membership area and via email.

If you need a medical record review while your loved one is in intensive care or after intensive care, we can help you with that as well. Any ICU in this day and age should just send you a link to a website with the username and the password, and you should have access to medical records. That’s a right, not a privilege. If they make it difficult for you, keep pushing or contact us. We can help you getting access to medical records.

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

Thanks so much for watching.

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

 

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