Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

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

Today, I want to talk about spontaneous breathing trials in ICU.

So, currently we’re working with a client who has their 88-year-old dad in ICU. He’s got pneumonia and he’s got a necrotizing fasciitis and he’s been ventilated for about 7 days now.

The ICU has tried spontaneous breathing trials, but they’re basically going from a controlled ventilation mode i.e. they’re giving him a breathing rate of 15 breaths per minute with a certain pressure that maintains a certain volume. Then, they’re going to a spontaneous breathing trial without reducing gradually the mandatory breathing rate. So, what that means is, if someone is getting 15 breaths per minute from the machine delivered every minute, it’s mandatory, then in order to wean someone off the ventilator, you can drop that rate down to 12, to 10, and see whether the patient can breathe up, that’s assuming all sedation and all opiates are off.

Now, in this particular situation, the ICU goes from a breathing rate of 15 to a rate of 0, and then says the patient fails the spontaneous breathing trial wanting to push for a tracheostomy.

I have worked in critical care nursing for nearly 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 confidently say we have saved many lives for our clients in intensive care. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast where we’ve interviewed some of our clients.

Now, cutting a long story short, the ICU goes from a mandatory breathing rate to a level of 0 to CPAP/pressure support where the patient needs to breathe spontaneously. That’s like running a marathon without training. That’s like sitting on the couch without any exercise and someone asks you to run a marathon. Well, you probably couldn’t because you’re not fit, you haven’t trained enough. It’s often the same with critical care patients when they need to be weaned off the ventilator towards a spontaneous breathing trial so that they can be extubated and have the breathing tube removed.

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. It’s exactly what this particular client was dealing with until we started helping them, because then we are holding ICUs to account and saying, “Look, this is not best practice.” And the ICU here in particular, they’re fostering their own agenda. They want to move towards the tracheostomy as quickly as possible so they can send the patient out to an LTAC facility.

This is a client in the U.S., and this is often what happens in the U.S. after tracheostomy and the PEG/Percutaneous Endoscopic Gastrostomy tube, ICUs want to send out patients soon to an LTAC as quickly as possible. LTACs are disaster area. They cannot look after ventilation and tracheostomy; I’ve made countless videos about that.

Once again, the biggest challenge for families in intensive care is 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. If you don’t know the ins and outs of intensive care like I do, they can do whatever they want, often not to the best interest of your critically ill loved one.

So, you need to understand what is best and what is in the best interest of your critically ill loved one. If you don’t know that, then you’ll be fighting an uphill battle; that’s why you need independent advice, someone that fights in your corner so that you know what the best next steps are.

Once again, think about it logically. You can’t go from a controlled breathing rate, from a controlled ventilation mode, where the machine is doing all the work to a spontaneous breathing trial just like switching over, that’s not going to work. When patients are ventilated in ICU every day, they’re losing breathing muscles, they’re getting deconditioned pretty quickly when they’re in an induced coma.

So, they have to regain their strength. They have to regain the strength of the breathing muscles in particular, and that often only happens by doing breathing exercises, by getting physical therapy, definitely by switching off sedation and opiates, and then by coaching them through it, which is what’s happening in this situation. It looks like the patient is now slowly but surely getting ready for extubation for having the breathing tube removed, but it wouldn’t have happened without our input and without our advocacy.

Intensive care is such a highly specialized area that unless you can verify what the ICU team is doing and suggesting to you that this is actually best practice and evidence-based practice, you shouldn’t believe a single word. You need to do your due diligence.

You are in a once in a lifetime situation when you have a loved one critically ill in intensive care and you can’t afford to get it wrong. There’s too much at stake and yet 99.9% of families in intensive care follow intensive care teams blindly even though they’ve got their loved one’s life in their hands. You can’t trust blindly, there’s too many agendas, mainly money, mainly bed management, mainly staff management that interfere with what is best for your critically ill loved one. I can confidently say that after I’ve worked in critical care for nearly 25 years in three different countries.

So, that is my quick tip for today.

We have helped hundreds and thousands of clients when they have loved ones in intensive care. Again, look up our testimonial section, look up our intensivecarehotline.com podcast and that’s why we created a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if 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 a 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’ve personally written and recorded. All of that will help you to make informed decisions, have peace of mind, control, power, and influence so that you make informed decisions and so that your loved one gets best care and treatment always.

I also do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, Skype, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly. When I talk to doctors and nurses directly, 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.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or 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, comment below what you want to see next, what questions and insights you have from this video.

Thank you so much for watching.

I also do a weekly YouTube live where I answer your questions live on the 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.

Related Articles:

Quick Tip for Families in ICU: You Were Absolutely Right, LTAC is a Complete Waste of Time After ICU! Quick Tip for Families in ICU: How to Avoid Euthanasia in ICU After Tracheostomy! Quick tip for families in ICU: Two steps forward one step back when your loved one is in ICU! (Part 2) Quick Tip for Families in ICU: Should You Stop Treatment if Your Loved One’s in Multi Organ Failure? Quick Tip for Families in ICU: Should your Loved One Go from ICU to LTAC with Multiple Comorbidities?