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

Today, I have an email from Alexandra who says,

“Hi Patrik,

My partner had a cardiac arrest a week and a half ago and he’s in ICU. He had a tracheostomy and he’s hopefully coming off fentanyl and sedation, but he’s very restless and although he responds to requests, I feel like I can’t help him to calm him down so that he’s not trying to pull at his tubes, et cetera.

I’m hoping it improves as he comes more out of sedation, but it is very hard to watch them look so uncomfortably. Is there something I can do other than talking to him?”

Thank you so much, Alexandra for your email and sharing this. There’s actually a lot you can do.

First off, when someone is having a tracheostomy, especially after cardiac arrest, I presume your partner hasn’t had any fractures, any other injuries, they should just stop sedation and opiates, pain relief. One of the main goals of a tracheostomy is to stop sedation and opiates straight away.

I’ve worked in critical care nursing for 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.

We have saved many lives with our consulting advocacy, and you can verify that on our testimonial section or on our podcast section both at intensivecarehotline.com. On our podcast section, we’ve done client interviews to verify what I’m saying.

So, with all my experience, when you do a tracheostomy, sedation and opiates should be switched off immediately. The only contraindication to that is if someone is having surgery, or is having fractures, or is waiting for surgery. There’s the exception to the rule but most of the time that is the purpose of a tracheostomy is to stop sedatives and opiates so patients can wake up and can be started on weaning off the ventilator and the tracheostomy ASAP (as soon as possible).  What’s the point otherwise?

So, the issue here can be that if someone has been in an induced coma (16) for a week, for a week and a half, which it sounds like has been the case in your partner’s situation that they might go through withdrawal. They might go through a withdrawal from the fentanyl. They might go through withdrawal if they’ve been on midazolam or Versed. If they’ve been on benzodiazepines for sedation, they might go through a withdrawal and that is what might cause, the fugitiveness, sometimes aggression, combativeness, or he’s pulling out tubes, he seems confused. So, that could be a sign of withdrawal, could also be a sign with the cardiac arrest that he might have a hypoxic brain injury or an anoxic brain injury that there’s some brain damage, but regardless of that, they need to stop sedation so you can actually see what he’s doing.

Now, I can appreciate that he looks very uncomfortable. I can appreciate that. Again, I’ve looked after thousands of critically ill patients and their families in ICU. I’m talking to families in intensive care all around the world every day of the week. So, I understand the predicament that your partner is in.

So, here is what needs to happen going forward as well. He needs to have physical therapy, he needs to get mobilized, he needs to get out of bed, he needs to have showers and don’t let ICU tell you they can’t do a shower while he’s in ICU. That’s nonsense.

Every good ICU that I worked in, we were showering patients regardless of their condition, with the exception if they were hemodynamically unstable, but as soon as they were stable, the tracheostomy did not stop us from showering those patients. Imagine the well-being that the patients feel if they have a shower after weeks in ICU. You can put them in a shower trolley. A good ICU will have that, and we’ll facilitate that.

So, other things you can do, of course, talk to him, make sure he gets physical therapy, make sure that they’re starting to mobilize him, get him out of bed, normalize him as much as possible, make sure you get a weaning plan, how are they planning to wean him off the ventilator? Get the steps, get access to the medical records so you can actually verify what’s documented and that what’s documented they’re actually doing, hold them to account.

If all fails, there’s always Intensive Care at Home. So, with Intensive Care at Home, we take long-term ventilated adults and children with tracheostomies home to provide the intensive care treatment at home. It’s a genuine alternative to a long-term stay in intensive care. So, have a look at intensivecareathome.com and get more information there.

But that should be your last resort. Your partner should be moving towards weaning off the ventilator and the tracheostomy as quickly as possible. That’s what I can see with everything that you’ve shared with me.

I’m just giving you options here and I’m just sharing with you what is actually best practice, and they may not be able to provide best practice to you because they may not have the staffing levels, they may not have the skills, they may not have the experience.

A lot of ICUs are struggling with adequate, not only staffing levels, but also if you have staffing levels, that doesn’t mean you have skills, experience, know-how. That’s a completely different story.

But I hope I’ve given you a hint what needs to happen next. If you need help, you know where we are.

We have helped hundreds of clients and members over the years here at intensivecarehotline.com with our consulting advocacy. Like I said, we have saved many lives which you can verify in our testimonial section at intensivecarehotline.com and also on our podcast section at intensivecarehotline.com where we have done client interviews.

You can be one of the clients in the long line of happy clients that we can help very, very fast, which is 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 the membership area and via email and we answer all questions intensive care related.

In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

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 handhold you through this once in a lifetime situation that you really can’t afford to get wrong. I also talk to doctors and nurses directly. When I talk to doctors and nurses directly, you will see the dynamic shifts very quickly because 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 suspect medical negligence.

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

I also do a weekly YouTube live where I answer your questions live on the show. You will get notification for the YouTube live if you are a subscriber to my email newsletter at intensivecarehotline.com or if you are a subscriber to my YouTube channel.

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.

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