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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
I had a question this week from a client who has their father in intensive care for about two weeks now. Initially they went into intensive care with a brain bleed. He wasn’t waking up. The Glasgow coma scale was anywhere between 3 and 8 and he’s still not woken up.
They had a tracheostomy to protect the airway and now they’re at the stage of where they have time off the ventilator, breathing with a trach collar and basically going back and forth between the ventilator and the trach collar and the client basically asked, how long should my father be off the ventilator at one time?
And the answer to that question really is that it depends. Some ICUs, they keep patients on the ventilator for two hours and off for two hours. See how they breathe. Are they struggling? Is it smooth sailing? Is their breathing rate adequate? Is it not too high? Is the oxygen saturation stable? Is it above 92%? Do they have a lot of phlegm coming up? How often do they need to suction? Do they have a good cough? Can they clear the airway? Are arterial blood gases supporting that your father stays off the ventilator? So those are all the questions that need to be answered.
But the bottom line is this. If your loved one can tolerate to be off the ventilator, the longer they can do it, the better. Let them go back on the ventilator for a few hours to half a bit of a break, especially overnight, so they can get a good rest overnight while they’re back on the ventilator, and then in the morning, start again.
Having a rest overnight while weaning off the ventilator is really important. And then they can have another go in the morning and that should be combined with getting people out of bed. They need to get mobilized. You can’t wean off the ventilator without mobilization. You can’t strengthen breathing muscles without sitting up.
Imagine you’re lying in bed after an induced coma for many days or weeks on end. People are getting deconditioned very quickly and therefore they need to start mobilizing as quickly as possible to get them off the ventilator.
And then once they can stay off the ventilator during the daytime, the next step is to eventually leave them off the ventilator overnight as well. And once they can stay off the ventilator for more than 24 hours and they’re not getting exhausted, they can breathe normally again, oxygen saturation is fine. They might need a little bit of oxygen. They might need some nebulizers and they might need a little bit of suction here and there.
But if they can stay off the ventilator for more than 24 to 48 hours, then 72 hours, I would argue the weaning process should be successful in combination with mobilization & physical therapy. That is so critically important.
So that is my tip for today.
If you have a loved one in intensive care, go and check out intensivecarehotline.com where we provide a professional consulting and advocacy service for families in intensive care.
Call us on one of the numbers on the top of our website, or send us an email to [email protected] with your questions.
Like this video, comment down below what do you want to see next and subscribe to my YouTube channel for tips and updates for families in intensive care. Take care for now.
This is Patrik Hutzel from intensivecarehotline.com. Have a great day.