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If you want to know what the signs of death or end of life are while a patient is in intensive care on a ventilator, stay tuned! I’ve got news for you, and I will answer that question today.

My name is Patrik Hutzel from intensivecarehotline.com, and I have another quick tip for you today for families in intensive care.

Like I said, this is a question that we get quite frequently, “What are signs of death or end of life while a critically ill patient is on a ventilator in intensive care?”

So first off, before I answer the question, I do want to highlight that approximately 90% of intensive care patients survive, that’s 9 out of 10. So, if you are watching this because you’re wondering if your loved one is dying because they’re on a ventilator, make sure you ask all the right questions and it’s good that you’re here. Just keep in mind, 90% of intensive care patients survive intensive care and leave intensive care alive. Keep that in mind while I’m answering today’s question.

Also, why can I answer the question? 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 very confidently say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section where you can read what our clients say. You can also verify it on our intensivecarehotline.com podcast section where we’ve done client interviews.

So, what are signs of death or end of life while on a ventilator in intensive care? When a person is on a ventilator, there are several things that may indicate that death or end of life is approaching. These signs can vary depending on the underlying condition and individual circumstances.

But some common indicators include decreased oxygen levels, the oxygen saturation levels measured by pulse oximetry, or blood gases may decrease despite ventilator support indicating that the body is no longer responding to treatment. You would see that FiO2 (fraction of inspired oxygen) on the ventilator in particular would most likely be 100%. You would also see that oxygen saturation in the pulse oximeter or in the arterial blood gas would be very, very low.

Next, profound decreased consciousness. The person may become unresponsive or semiconscious and unable to interact with others or respond to stimuli. It can only also happen, that a patient then is on sedation and also on opiates, making sure they’re not suffering if they are approaching end of life, but they may seem to be unresponsive and unconscious without sedation and opiates given.

Next, decline in heart function. The heart rate may slow down significantly or become erratic, or blood pressure may drop to dangerously low levels despite interventions. When the heart rate becomes erratic, in particular, that could result in V-Fib (ventricular fibrillation) or VT (ventricular tachycardia) or Afib (atrial fibrillation) or SVT (supraventricular tachycardia), but it is then also often resistant to treatment. If blood pressure is dropping to dangerously low levels that might be incompatible with life, which can also happen in situations like that, you will also see that patients then get started on inotropes or vasopressors such as noradrenaline, norepinephrine, epinephrine or adrenaline, vasopressin or phenylephrine, dobutamine, dopamine, those medications might be commenced then as well.

Next, labored or irregular breathing. Even with a ventilator, breathing may become irregular, labored, or shallow. In some cases, there may be signs of fluid build-up in the lungs, making it harder to get enough oxygen. That is really dependent on whether what ventilation settings a patient is in. So, if they are in a set rate like SIMV (synchronized intermittent mandatory ventilation) or ACV (assist control ventilation), and they’re not sedated, then this can happen. If they are in ACV, or SIMV in a controlled ventilation mode, then they may not breathe because the machine is doing all the work for them whilst they are sedated. So, you always have to weigh out what is really happening. That’s why I’m saying, “The devil is in the detail.”

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.

Back to answering our question today, poor blood circulation, cold hands and feet, pale or mottled skin and reduced urine output may be signs that the circulatory system is failing. Once again, that also comes back to my earlier point about low blood pressure, erratic heart rhythm, which ties in with that as well.

What also ties in that is my next point, which is multiorgan failure, which is the failure of multiple organs such as kidney, liver, heart, even the brain, can indicate that the body is shutting down. What I said in an earlier point, you will see that feet and hands are getting mottled, are getting blue. The lips are getting blue – cyanotic. So, those are all signs that someone might approach end of life.

Next point, increased sedation. High doses of sedatives may be necessary to keep the person comfortable, indicating a significant decrease in the body’s ability to fight or recover. That also ties in with increased use of opiates such as morphine or fentanyl to achieve the same— keep a person comfortable and ideally free of pain.

Next point, changes in ventilator settings. If ventilator settings need to be increased or adjusted frequently to maintain adequate oxygen levels, it may indicate that the person is no longer responding to treatment effectively.

These are the signs that are usually evaluated by medical professionals, ICU doctors, ICU nurses who will assess the person’s overall condition and make decisions about the continuation of life support or discontinuation of life support based not only on the prognosis but also based on patient and family wishes. That is always important that it’s up to patients and families what they want.

One other thing that also is a sign that someone might be approaching the end of life when they’re on a ventilator is usually high lactate levels in the blood results, whether that’s through an arterial blood gas or through a venous blood sample. Also, PO2 (partial pressure of oxygen) in the arterial blood gas is very low and usually PCO2 (partial pressure of carbon dioxide) or carbon dioxide is very high, leading to sometimes respiratory acidosis and other respiratory issues, but that’s giving you a good overview.

We have helped hundreds and hundreds of members and clients over the years when they have a loved one in intensive care to improve their lives instantly.

That’s why I provide 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 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 with you or on your behalf. When I do that, 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.

We also have a membership for families of critically patients in intensive care, and you can become a member if you go to intensivecarehotline.com and 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. Those videos and eBooks will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment, always.

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 or what questions and insights you have.

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 intensivecarehotline.com email newsletter at intensivecarehotline.com.

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.

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