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

So, when people opt-in for their free instant impact report or for their free video mini course, we ask them, “What is their biggest frustration?” And we get a lot of insights. And a lot of the videos that I’m making here are actually coming from the feedback that we are getting when people write in their biggest frustrations. So, one of our readers wrote in what’s their biggest frustration, “Not knowing what questions to ask the uncertainty of it all and what is considered progress when weaning someone off a ventilator?” What a great question to ask and let’s dive right into it.

So, first of all, you absolutely need to know what the right questions to ask  are and you can really only ask the right questions if you have someone on your team that understands intensive care inside out.

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 questions to ask. They don’t know what to look for. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care.

And, I’ve worked in intensive care for over 20 years in three different countries. And out of those over 20 years, I’ve worked as a nurse unit manager in intensive care for over five years. So, you would expect that I can ask the right questions. And the devil is in the detail when it comes to intensive care.

So, what is considered progress when someone is on a ventilator in intensive care? And how can you look for the signs that someone can be taken off the ventilator? Probably make a distinction here between, when someone is on a breathing tube in the mouth or on a ventilator with a tracheostomy. Again, this is a very broad question that our reader is asking, “What are considered signs to come off the ventilator.” Again, then I need to break it down and say, “Okay, what do you mean? Are you talking about someone being weaned off the ventilator with a breathing tube or with a tracheostomy?” So, the devil is in the detail.

So, today let’s focus on ventilation with a breathing tube. What are the signs? So, when someone is going into intensive care with a breathing tube on a ventilator, they are usually induced into a coma for many reasons, surgery accidents, COVID, ARDS (Acute Respiratory Distress Syndrome), all sorts of reasons why someone ends up in intensive care on a ventilator. I’m not going into detail today, but the waking-up process is almost the same for every patient. They need to slowly come out of the induced coma instead of being in a controlled ventilation mode, such as SIMV (Synchronized Intermittent Mandatory Ventilation) or AC (Assist Control). They need to be moved on to an assist control mode, such as CPAP (Continuous Positive Airway Pressure) pressure support. And if their tidal volumes are adequate, if their minute volumes are adequate, if the PEEP (Positive End-Expiratory Pressure) is down to a minimum of 7.5, if the pressure support is down to a minimum of 10 or 8, if they’ve been breathing on pressure support such as CPAP for more than 24 hours, if they can obey commands, if they’re awake, if they have a good cough, if they can sit up, if the arterial blood gases are adequate, that’s usually when someone can be extubated.

But even there, we could break it down even further into what does need to happen on an arterial blood gas? How long does sedation need to be off? What do blood results show? Is there any further bleeding? Is the patient still on inotropes or vasopressors? Is the patient on dialysis? The devil is in the detail and everything needs to be looked at from a holistic point of view and everything needs to be looked at in much detail before you can make such a crucial decision to take someone off the ventilator because you don’t want to take someone off the ventilator and then have to reintubate within less than 24 hours, you can do more damage than good. So, the devil is absolutely in the detail.

That is my quick tip for today.

Next time, I will do a quick video about how to wean someone off a ventilator when they are on a tracheostomy. Look out for that.

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.

If you need a medical record review while your loved one is in intensive care or after intensive care, you can contact us as well.

And, subscribe to my YouTube channel for regular updates for families in intensive care and Intensive Care at Home, share this 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, and of course, give it a thumbs up if you like the video.

Thanks for watching.

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