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

So, today is another success story from one of our clients who has their husband in ICU and the husband got intubated after initially was put on BIPAP (bilevel positive airway pressure) in the Emergency Department, then deteriorated quickly with respiratory failure and needed to be intubated. After about 10 days of ventilation in ICU, the family was told that the only way forward is a tracheostomy and sending into LTAC. Obviously, this is for our US clients, in particular, because this client is in the US. Then, we looked at medical records and we could see, and we knew from the family was actually passing spontaneous breathing trials, but the ICU was trying to work them up and word them up for tracheostomy and PEG (Percutaneous Endoscopic Gastrostomy) and send him out to LTAC (long-term acute care).

Now, interestingly enough, we looked at the situation and he seemed to be over sedated with Fentanyl in particular and Precedex, especially during the nighttime. Also, he was restrained physically as well as chemically because when you think about it, Fentanyl and Precedex are chemical restraints as well.

So, because he was passing spontaneous breathing trials, we suggested that they should take away all sedation, should take away the restraints to make him feel at ease because the restraints made him very agitated, made him very uncomfortable, made him paranoid even. Imagine you’ve got a breathing tube in your mouth and you’re waking up, you don’t know what’s happened and then your limbs are restrained. Someone needs to take the restraints off and actually bring in peace and calm to this patient without chemical restraints and physical restraints.

So, he kept passing the spontaneous breathing trials for a few hours a day, but he was still sedated. So, we went back, and we actually wrote to the ICU, and we said, “Look, it would be good if you could take the physical restraints off as well as the chemical restraints and see whether he can pass more spontaneous breathing trials.” It took about 48 to 72 hours until the client got extubated. Successful extubation means the removal of the breathing tube.

Now, I have made a video a while ago where I talk about how to wean critically ill patient off the ventilator and the breathing tube. One of the main ingredients there is to wean off sedation. So, to get patient compos mentis, to get them to wake up, obey commands, do spontaneous breathing and then you can take the breathing tube out if some boxes are ticked, including arterial blood gases must be good etc.

But it is another sign that (A) the easier way out sometimes for ICU is just do a tracheostomy and the PEG and ship them out. Out of sight, out of mind because it takes sometimes a lot of work to get someone off the ventilator and extubate them. There can be some trial and error. There’s a limited window of opportunity for extubation, but more importantly, the ICU was sort of saying, “Well, we make the decisions.”

Well, the bottom line is that, in this particular case, when we look at medical decision making; well, it’s actually the families making the decision. So once again, we wrote to the hospital and saying, “Look, it’s actually not you making the decision, it’s actually the family is making decision assuming it is within safe parameters, which we thought that was the case.”

So, what have I been saying for a long time? I’ve been saying for a long time that hospitals are very good to pretend they can do whatever they want. Well, do you think that life or death situation in intensive care, they come with certain rules, regulations, policies, and laws. It doesn’t happen in a vacuum.  You need to keep that in mind. Intensive care does not happen in a vacuum.

Patients do have rights; families do have rights and that’s what we exercise in this situation to get this patient off the ventilator and the breathing tube and not let him go for tracheostomy and for a PEG tube and then go to LTAC. Don’t get me wrong, tracheostomy have their time and their place, and I’ve said that many times as well, but you got to know when a tracheostomy is the right thing to do, and you have to know when to avoid it. But that only comes with experience.

I mean, I have worked in intensive care/critical care for nearly 25 years in three different countries where I also work as a nurse manager for over 5 years. So, that is what I’ve been doing for a long time, and I’ve been consulting and advocating  for families in intensive care since 2013 here at intensivecarehotline.com. I can say without the slightest hint of exaggeration that we’ve saved many lives with our consulting and advocacy or changed the trajectory of recovery like we have in this instance. Most likely, shorten recovery times, making it possible for patients to go home from hospital rather than going to an LTAC.

That’s why it’s so critical you get a second opinion. That’s why it’s so critical you get insights and education about what are your rights. Intensive care teams do not operate in a vacuum. They want to pretend they operate in a vacuum but they’re actually not, but you have to know what to do and how to position things.

That’s also one of the reasons why we created the membership for families of critically ill patients in intensive care at intensivecarehotline.com. You can click on the membership link there and become a member there or 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 access to 21 eBooks and 21 videos that I wrote and also recorded for you so that it will help you to steer this incredibly difficult territory that is intensive care, but it will help you to make informed decisions, have peace of mind, control, power, and influence that will help you making sure your loved one gets best care and treatment.

I also offer one-on-one consulting and advocacy for families in intensive care. I talk to you and your families directly. I 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 in intensive care.

I also represent you in family meetings with intensive care teams.

We also offer medical record reviews for families in intensive care, for patients in intensive care so you can get a second opinion once again, making sure you make informed decisions, have peace of mind, control, power, and influence so that your loved one gets best care and treatment. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply 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 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 you want to see next, what questions and insights you have.

Thank you so much for watching and this is Patrik Hutzel from intensivecarehotline.com.

I’ll talk to you in a few days and share the video with your friends and families as well.

Take care.

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