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If you want to know if your wife can come off the ventilator in intensive care, if she’s been there for about 7 days and she’s not waking up, stay tuned. I’ve got news for you.

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

So today, I have an email from Roger who says,

“Hi Patrik,

My wife has been in ICU for 8 days now. 8 days ago, I found her, and she was agonal breathing and had been sick with flu-like symptoms. She has extreme COPD (chronic obstructive pulmonary disease) due to smoking. When I found her, I called 911 and I began giving her CPR (cardiopulmonary resuscitation) as instructed by the 911 operator until the paramedics arrived exactly 6 minutes after the call. Emergency services took over for me doing CPR and had to start her heart as it had stopped.

They restarted her heart immediately. Rushing her to the hospital where she has been ever since on a ventilator, she was on 3 sedatives now down to just 1 but doesn’t seem to be able to tolerate any less sedation. The doctors also found two bacteria and a small amount of mold in her blood, which is being treated with antibiotics. They are beginning to talk of giving her tracheostomy in 4 to 5 days. They don’t seem to think. She will be able to come off the ventilator and will need help to breathe with a tube for some time to come. What is the best approach and course of action to a situation like this?”

Her heart tests showed no problems, and when sedation is lowered, she does have some response, but also anxiety makes her unstable.”

Thank you, Roger, for writing in. 

So, there are a few things missing that I think are important here, obviously with the cardiac arrest. Did she have any brain injury, hypoxic brain injury, anoxic brain injury? You’re not mentioning any of that. Have you looked for that? Do you have access to the medical records? That’s one question. The other question is, what sedation is she on? Is she potentially withdrawing from sedatives such as midazolam or Versed because she’s now addicted to it? Because it’s a benzodiazepine, which is addictive, that needs to be looked at. That question needs to be asked. The other question that comes out of this is, what are they doing beyond the shadow of a doubt to get your wife off the ventilator and the breathing tube to wake her up? If she’s on multiple sedatives, that’s not a good recipe to wake up.

Now, granted, it can happen that if you try to wean someone off sedatives and opiates, they don’t wake up, or they get agitated, they get combative, they get confused. That is certainly something that I’ve seen over and over again. But that doesn’t mean they should stop trying and just move to a tracheostomy straight away. A tracheostomy should be done between day 10 and day 14 of mechanical ventilation with a breathing tube and the inability to wean off the ventilator. But the question is, have they even tried? I’m not hearing that. What ventilator settings is she breathing on? I’m not hearing any of that from you.

If she has anxiety, if you think she has anxiety, or if they can pinpoint that she has anxiety, that is actually not necessarily a bad sign. That actually means her brain is working. Because the biggest question to me here is, is there a hypoxic or anoxic brain injury as part of the cardiac arrest and the CPR that was delivered by the ambulance crew or by yourself even? A tracheostomy has its time and its place. And I’m not saying yes or no to a tracheostomy. It has its time and its place, but the first question is, what ventilator settings is she on? What sedatives and opiates are she on exactly?

How are kidneys and liver working? Can the opiates and the sedatives be metabolized or getting washed out of the body through the kidneys so that it’s not hanging around in the body, you know, keeping her sedated? Those are all questions that need to be answered. It also sounds to me from your email that your wife has some form of infection, potentially even a sepsis, which will probably delay her waking up. That is also a consideration.

But in a nutshell, Roger, 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. That is exactly what you are up against at the moment. You don’t know what you don’t know.

To summarize the action steps from here, ask them what they are doing beyond the shadow of a doubt to get your wife off the ventilator and the breathing tube and avoid the tracheostomy. That is your number one most important question. Number 2, do you have access to the medical records? Get access to the medical records. Number 3, make sure that she’s getting off sedatives and getting off opiates. Number 4, find out what infection she exactly has. Number 5, what ventilation settings is she on? Number 6, what ventilation mode is she in? Has she passed any spontaneous breathing trials? And Number 7, are kidneys and liver working?

Obviously, like I said, when you have access to the medical records, have a look whether there’s been a hypoxic or an anoxic brain injury. Have they done a CT scan of the brain, an MRI scan of the brain? Also, when you talk to her, and you ask her to squeeze your hands, is she squeezing your hand? Because that would be a very good sign. Or if you ask her to open her eyes, is she opening her eyes? Can she wiggle her toes, for example, if you ask her. Look for those things to take the next steps here. I’m all for a tracheostomy for the right patient, but she may not be the right patient.

That’s what you need to work out, because get a tracheostomy or no tracheostomy could be a difference between day and night. Recovery without a tracheostomy would be so much quicker. So, avoiding it would be the goal here.

I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse manager for over 5 years, and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our clients here at intensivecarehotline.com. You can verify that on our testimonial section, and you can verify it on our intensivecarehotline.com podcast section, where we’ve done client interviews.

That’s why we are giving life-saving advice. We’re giving life-saving advice, and we will change your life to the better as well. We change your loved one’s life better to the better as well. We’ve done it many, many times and we have a proven track record.

We have helped hundreds and hundreds of members and clients over the years to improve their life instantly, making sure their loved ones get best care and treatment. And with that track record, we can change your life as well, by giving you lifesaving advice and you can join a growing number of hundreds and hundreds of members and clients over the years that we helped to improve their lives instantly.

That’s also why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever meeting works best for you. I talk to you and your families directly. I handheld you through this once in a lifetime situation that you simply cannot afford to get wrong. I also talk to doctors and nurses directly with you or on your behalf, 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 regular reviews in intensive care so that you can get a second opinion while your loved one is critically ill in intensive care with a medical record review.

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.

We also have a membership for families of critically ill patients in intensive care at intensivecarehotline.com. You can 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 eBooks and 21 videos that I have personally written and recorded, making sure that you make informed decisions, have peace of mind, control, power, and influence so that your loved one gets the best care and treatment always.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers at the top of our website or send us an email at [email protected] with your questions.

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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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