Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So, Stephanie has an email, and she says, “Hey, what are the signs that my mom can be weaned off the ventilator? She’s in ICU with pneumonia and she’s got a pneumothorax as well.”
So, Stephanie, there are several signs to look for, before someone can be weaned off the ventilator. You haven’t actually shared whether your mom is ventilated with a breathing tube in her mouth, or with a tracheostomy in her throat. You haven’t actually shared that, but let’s just assume she’s ventilated with a breathing tube in her mouth, to begin with.
Now, before I go into the details, like this video, share the video with your friends and families if you find value in it, and subscribe to my YouTube channel for regular updates for families in intensive care.
Now, let’s dive right into it.
So, your mom needs to be off sedation. Assuming she was in an induced coma for the breathing tube, she needs to be off sedation, and off opiates or pain medicine completely. She needs to be awake. She needs to be able to follow simple commands such as poke out her tongue, squeeze your hands, wiggle her toes, and simple stuff like that.
Next, she needs to have a good, strong cough. Because once the breathing tube is out, if she can’t cough, she can’t protect her airway. That’s number two.
Number three, she needs to have good arterial blood gases, good partial pressure of oxygen (PO2) or oxygen levels in the blood, and good partial pressure of carbon dioxide (PCO2) or good carbon dioxide levels in the blood to make sure that the gas exchange in the lungs is actually working.
Next, on the ventilator itself, she needs to breathe in continuous positive airway pressure (CPAP) or pressure support with minimal positive end-expiratory pressure (PEEP). PEEP of 5. Minimal pressure support, usually 10 or less, probably 8 or less is even better. And her tidal volumes need to be good. They need to be adequate to her weight, 7 to 10 mls per kilo. Which means for simplicity, if someone weighs 80 kilos, they need to breathe roughly around seven to 800 mls per breath. And fraction of inspired oxygen (FiO2) or oxygen that she’s getting through the ventilator, needs to be below 30 to 35 as well.
Now those are the signs in a nutshell. She needs to be able to sit up again, cough, then go. Once the breathing tube is out, she needs to be able to cough as I said. Sit up, get out of bed, and get mobilized, assuming she doesn’t have any fractures.
Now, you mentioned with your mom’s situation, that she has a pneumothorax. She will have a chest drain for that. Now that shouldn’t stop her from getting extubated. If she’s otherwise ready, you got to look for the drainage of the chest drain. Is there any blood coming out? Or any other fluids? Or is there nothing coming out at all? Which is obviously a good sign.
If your mom has a tracheostomy, pretty much the same applies with the difference that, with a tracheostomy, you can go back and forth from the ventilator and off the ventilator. It’s very easy with a tracheostomy. You can switch between ventilation and the tracheostomy mask or tracheostomy shield.
And it’s actually a much easier process and you have more time. There’s less room for error, really. You can assess if, can someone cough? Can they clear their own airway? But it’s often also a longer process. Sometimes you may have to downsize the tracheostomy first before you can actually remove it, but I’ll make a separate video about that on another day.
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 the website or send us an email to [email protected].
We also offer medical record reviews for your loved ones in intensive care, either while they are in intensive care or after they’ve been in intensive care, to answer your questions and making sure the intensive care team is telling you the full story. Most of the time, they’re not telling you the full story. And we can help you with getting down to the nitty and gritty and making you really understand what is actually happening in intensive care without leaving important details out.
Again, like the video, comment below what you want to see next, subscribe to my YouTube channel , click the notification bell, and share this video with your friends and families.
This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.