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

So, currently we are working with a member, who has their 78-year-old husband in ICU. He’s now in ICU for a few weeks and couldn’t come off the ventilator. He ended up with the tracheostomy and he’s now going through the process of being weaned off the ventilator and the tracheostomy.

Now, initially, our member’s husband got extubated, had the breathing tube removed and then was put on CPAP (continuous positive airway pressure) because he wasn’t quite ready to breathe yet. Then, he aspirated and had to be reintubated, which then eventually led to the tracheostomy now.

But I remember I had a question saying that when they extubated him, i.e., removed the breathing tube in the first place, she thinks they didn’t switch off the feeds after I asked her, do you think they had switched off the nasogastric tube feeds? Because before you extubate someone, you need to stop the feeds for at least 4 to 6 hours. She thinks that hasn’t happened i.e., she then asked, “Would that be considered as medical negligence?” Well, I think, it’s a clear mistake not stopping the feeds before you extubate someone because you should extubate on an empty stomach.

Again, extubation is the removal of the breathing tube and you should be doing that on an empty stomach because the removal of the breathing tube can be very irritating and can trigger a vomit and nausea if there is no empty stomach.

So, an aspiration after an extubation, i.e., if gastric content goes into the lungs, can rapidly decrease respiratory function and lead to another intubation, i.e., patients going back on the ventilator again with a breathing tube because the BIPAP (bilevel positive airway pressure) or the CPAP won’t be enough to keep a physiological respiratory function present.

So, for someone that has a loved one in intensive care, and they are ready for extubation, you absolutely need to check that they’re doing all the right things and one of those things would be to stop feeds at least 4 to 6 hours. Most patients that are intubated in ICU, i.e., have a breathing tube, have a nasogastric feeding tube.

So, I have also written an article and made a video about, “How to wean a critically ill patient off the breathing tube and the ventilator?” and that would be part of the checklist there that feeds need to be stopped 4 to 6 hours in advance or before the extubation and other boxes need to be ticked as well before someone can be safely extubated and it’s all in the article and I’ll link to it below this video. There’s an article in the video, “How to wean a critically ill patient off the breathing tube and the ventilator?” and you can find more information there.

Now, if you have a loved one in intensive care, go to 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.

Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There, 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.

I also offer one-on-one consulting and advocacy over the phone, via Skype, via Zoom, WhatsApp, whichever medium works best for you. I talk to doctors and nurses directly. I ask all the questions you haven’t even considered asking because I’ve worked in intensive care for over 20 years in three different countries. I looked after thousands of critically ill patients and their families in intensive care. So, I can answer all your questions and I can ask all the questions that need to be asked to intensive care teams.

We also offer medical record reviews in real time so you can have a second opinion in real time. I also represent you in family meetings with intensive care teams once again, so that you have someone on your team that can represent you and ask all the questions again you haven’t even considered asking but need to be asked to make sure your loved one is getting best care and treatment and therefore best outcomes. If you want a medical record review after intensive care because you have unanswered questions, you need closure, or you are simply suspecting medical negligence, please contact us as well. We can help with that as well.

Now, if you find value in my videos and you like them, subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have.

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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