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If you want to know how to focus on both wound healing and ventilation weaning while your loved one is in intensive care, stay tuned! I’ve got an update for you there today.

My name is Patrik Hutzel from intensivecarehotline.com and here is another quick tip for families in intensive care.

So, today I want to read out an email from one of our members we worked with earlier in the year who had her father in intensive care. I’ll read out an email from her and how we answer questions for our members, and you can follow them through because if you want to become a member, if you have a loved one in intensive care, you’ll get the same level of service and the same level of attention that you get with the email that I’m reading out in a minute.

“Hi Patrik,

My father has a foot wound on his heel that was previously surgically drained, biopsied and debrided and treated with IV antibiotics. He had a wound back dressing and then the wound was dry, nothing growing in the culture stated. He was transferred and finished his course of IV antibiotics for blood infections.

When I noticed the foot bandage was not being changed or checked each day and asked the nurse about it, she showed me that her directions were to only change if the bandage appeared dirty or there was a bad smell coming from it. I spoke to the doctor and got assurance that the wound care physician was changing the bandage every two days and monitoring it because they didn’t want to disturb new skin growth. We were assured that there was no infection, no drainage and no need for it to be escalated to a surgical consult.

Then the wound care doctor met with my elderly mother alone and said the wound doesn’t look good and part of it looks soft and they will debride the wound but probably can’t handle this type of wound and someone else will need to potentially do a foot amputation. This was right after a family meeting when they assured us, he would have access to a foot ankle surgeon if needed, and that wound care was communicating with the infectious disease doctor.

I can’t now take my father to see his podiatrist, foot ankle specialist surgeon, because he’s still in ICU and he aspirated and getting a pneumonia when he needed to be put on a ventilator and then finally had a tracheostomy and is in the process of weaning. The weaning is going well, he’s breathing on CPAP for about 7 to 8 hours per day at a very low-pressure rate, and respiratory therapy has recommended to start him on the T-Piece. T-piece is also known as the trach collar or trach mask. I don’t want to set back his weaning process and progress, but I can’t ignore the possibility of a bone infection and it not being monitored and him taken off the antibiotics too early.

How should I best ask for both to be addressed? All of this is complicated by the ICU giving me doctor’s orders, progress notes and nurses notes. My mother and I are supposed to be satisfied with the nurse explaining to us verbally if they have the time. I asked for the notes and offered to pay. They have updated me that if I pay for the pages, I can have a printout, but it will be weeks afterwards.”

Before I go into our email response, I also want to say getting access to medical records is a right and not a privilege so don’t let anyone dissuade you. We hear it all the time that the hospitals reject giving access to the medical records. Do not let dissuade you from getting access to the medical records. It is a right, not a privilege. You need to put the pressure on.

Our clients, generally speaking, never have a problem in getting access to the medical records by being persistent and by exercising their rights. Hospitals are very good to pretend that they can do whatever they want. Well, unless until they can’t because you put the pressure on. A complaint to hospital executive might also help you in a situation like that where you make a complaint to hospital executive that you haven’t got access to medical records yet, demand access to the medical records with a deadline and you’ll see that things will change, but you will need to be persistent because the hospitals are often playing dumb as well.

So, now let’s read out our response here.

“Hi Heather, thank you for your email and for sharing some of the clinical progress of your dad and his care, his foot wound, and management of his respiratory weaning.

Pressure ulcers or how deep the wound is progress through several stages. So, Stage 1 ulcers have not yet broken through the skin. Stage 2 ulcers have a break in the top two layers of the skin. Stage 3 ulcers affect the top two layers of the skin as well as fatty tissue. Stage 4 ulcers are deep wounds that may impact muscles, tendons, ligaments and bones. Staging helps determine what treatment is best for your dad.

Do you know what stage is your dad’s wound or pressure ulcer? You can send us pictures of it so we can see the images of his wound. It is absolutely essential to emphasize the importance of close monitoring for wounds that have undergone drainage, biopsy, debridement and treatment with IV antibiotics to avoid recurrent infections and facilitate healing.

The approach of changing wound dressings only when they appear dirty or emit a bad smell is not ideal for wound care practice at all. Regular wound assessment and care from the wound care team are crucial for ensuring your dad’s wound heals properly and remains free from infection. The information you receive from the wound care doctor about the need for further debridement and possible referral to a specialist is indeed concerning, especially following assurances of no infection, no drainage, and no need for a surgery consult.

Regarding the weaning of the ventilator, it’s good to hear that your dad is making progress with CPAP and the recommendations to start him on a T-bar, T-piece, or a trach collar, or trach mask.”

Now, what you also need to know is, you are making reference in your email that your dad is on low pressure settings. So, here is when patients go from CPAP over to T-piece, or T-bar, or trach mask, or trach collar. They must be breathing on CPAP for several hours, sometimes more than 24 hours. PEEP (positive end expiratory pressure) usually needs to be 5, 7.5, or less. Pressure support usually needs to be 10 or less. The tidal volumes i.e. the volume your dad is breathing needs to be between 7 to 10 mls per breath per kilo. So, if your dad is 80 kg, for simplicity, he should breathe between 500 to 800 mls roughly per breath. The breathing rate should be around 10 to 25, 30 at the most. No shallow breathing, no fast breathing, no use of accessory breathing muscles such as the abdominal muscles. Oxygen saturation should be above 94% consistently. Arterial blood gases should be within normal range, and oxygen or FiO2 on the ventilator should be less than 35% ideally. Please keep in mind, once again, room air consists of 21% oxygen. So, that’s pretty much the indication when your dad can go from CPAP to a spontaneous breathing trial on T-piece, T-bar, trach collar, trach mask.

Let’s continue with the email.

“It is also important that they address and manage promptly his foot wound especially since the wound care physician is addressing further referral to a specialist. This is essential to prevent serious complications such as the bone infection you’re concerned about should the wound remain unaddressed and untreated. Have they done any foot CT scans to determine the extent of the wound? Are they offloading pressure on his foot? Has he been provided with a special type of mattress? Are they mobilizing him like sitting him up on a chair which will also help him with ventilation weaning? A prompt evaluation by the wound care team and the infectious disease specialist for possible restarting of antibiotics along with the consultation from a foot and ankle surgeon is advised to address his foot wound and determine the next course of intervention for him.

Otherwise, it’s good to know that you are working towards obtaining the medical records. It’s best that we also see and review your dad’s medical records so we can better understand the details of his condition and the details of his progress and provide you with even more precise advice.

I hope that help, Heather. If you have any other questions, please let me know.”

So that’s how we help our members in very much detail, explain things in very much detail to our members because we have built the membership for families of critically ill patients in intensive care. As you all know, the hospitals are in a big, big mess worldwide, but especially in English speaking countries, and we are providing a platform here at intensivecarehotline.com where families in intensive care can get help very fast.

I have worked in critical care for nearly 25 years in three different countries where I also 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. We have improved many lives for our clients, and you can verify that on our testimonial section or on our podcast section at intensivecarehotline.com where we have done some client interviews. If you want to become a member for our membership for families of critically ill patients in intensive care, you can go to intensivecarehotline.com, click on the membership link and sign up there or you go to intensivecaresupport.org directly and you can sign up there.

We create a really good platform where people can come together and share their frustrations, and you get answers from us so that you can get a second opinion because you can’t do this alone. If the minute you think you can do this alone, you won’t be getting the outcomes that you will get with us, and once again, you can look up our testimonial section. If you think you can do this alone, you are in a once in a lifetime situation that you can’t afford to get wrong, and most families do get it wrong if they don’t get help.

In the membership, you also 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. You also have access to 21 eBooks and 21 videos that I have personally written and recorded sharing all my decades worth of intensive care nursing experience with you, making sure you make informed decisions, you have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

I also offer one-on-one consulting and advocacy for families in intensive care 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 process. I’ve worked with thousands of critically ill patients and their families over the years either in ICU or here with our consulting and advocacy. I’ll make sure you stay two steps ahead of the intensive care team so that you can manage them, and they don’t manage you. The longer you wait to get help, the higher chances you won’t get the outcomes that you need and want for your critically ill loved one.

I also talk to doctors and nurses directly and 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 offer 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 simply send an email to support@intensivecarehotline.com.

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 do you want to see next, what questions and insights you have, and share the video with your friends and families.

I also do a weekly YouTube live where I answer your questions live on a show and you get notification for the YouTube live if you are a subscriber of my YouTube channel or if you are a subscriber of our email newsletter that you can subscribe to 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.