Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So what we’re currently seeing, especially with COVID goes rampant, especially in the Northern hemisphere in the United States and in the UK is that patients that should have a tracheostomy after day 10 to day 14 are not having a tracheostomy because of the risk of COVID spreading to the ICU staff if tracheostomy is being performed.
So that impacts on patients quite significantly, because they are kept in a coma sometimes for longer than usual and for longer than necessary compared to what’s happened before COVID hit the ICUs.
So we are now seeing that patients on a ventilator with a breathing tube are kept in an induced coma for much longer, often after day 20 or day 25, they’re still having a breathing tube and are still in an induced coma.
One of the major advantages of a tracheostomy after day 10 or day 14 is that people can be basically taken off sedation and opiates because the tracheostomy doesn’t cause any pain or discomfort like the breathing tube or the endotracheal tube.
So that’s impacting on recovery times for patients because simply being kept in an induced coma for longer than necessary, just gets patients very weak, they’re not using their muscle tone, they are losing muscles and just getting deconditioned very quickly and that is a big, big challenge.
So another thing that you should know is a lot of patients with COVID in ICU are more or less in ARDS or lung failure. They’re often being proned, in prone positioning, which means they need even more sedation. They’re often on muscle relaxants as well or paralytics so that they can tolerate the prone position.
So the sooner, once again, someone can have a tracheostomy, the better, but we are seeing it’s getting very late, later and later, before patients can have a tracheostomy.
The other issue that goes hand in hand with this is if patients are in severe ARDS, their oxygen requirements are high, their PEEP requirements are high, they’re often on nitric oxide and if they have oxygen requirements about 50 or 60% FIO2, if they have a PEEP above 8 or 10, which often is the case in ARDS, it’s too risky to do a tracheostomy. So that’s another reason why a tracheostomy is often delayed.
So what should you do in a situation like that? Well, often all you can do is wait. But you shouldn’t wait too long. I haven’t seen that ICU’s are adapting in terms of doing tracheostomies that are safe. I haven’t seen them adapting yet. It is certainly dangerous on the level that if a tracheostomy can’t be performed and patients are not improving, that ICU’s are pushing more and more for DNR (Do Not Resuscitate orders) or basically want to move patients to hospice or to palliative care and let them die. So that is certainly one the biggest risks in all of these.
In any case if you have a loved one in intensive care, whether with or without COVID, you should definitely contact us at intensivecarehotline.com. You can call us on one of the numbers on the top of our website because it’s inevitable for any family in intensive care to get professional help.
If they have a loved one in intensive care because simply families in intensive care don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask, and they don’t know how to manage doctors and nurses to get the outcomes that they want for their loved ones.
The reality is, the intensive care team is probably only telling you half of the story, unless you have a professional that’s worked in intensive care for decades like I have, you can ask all the right questions.
You will never find out what’s exactly happening. They’re probably withholding critical information that you’ll only get from someone that has worked in the environment for decades and can ask the doctors the right questions.
That’s it for today, like the video, subscribe to my YouTube channel for updates for families in intensive care, and leave a comment below this video, any questions that you have, any videos that you would like to see.
This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days.