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

So today, I’ve got an email from Diane who says, “My 52-year-old sister is in ICU, and they want to take her off the ventilator this morning but couldn’t because she was too agitated. So, they made her go to sleep again and said they would try again tomorrow morning.

My sister suffered from a fall and broke her clavicle, some ribs, and her ankle and was in a lot of pain. My sister is also suffering from alcoholic dementia. I am worried that she will die tomorrow because the doctor told me he talked with my sister, and they said to not reintubate her if she’s agitated again for a second time tomorrow.

There is nothing I can do to change their minds. They say she’s not competent enough to make the decision. But when I asked her this morning if she wanted to stay alive, she said yes with her head. Yesterday, she wrote me a note asking to have a TV to watch because she had nothing to do. This doesn’t sound like a person that is not competent. I’m very worried she will die tomorrow. I am her next of kin.” Thank you, Diane for sharing this.

There’s a number of things here. You shouldn’t be too concerned about the ICU team letting her die. What you should be concerned about is controlling what you can control, especially if you’re the next of kin. If they let her die tomorrow and not save her life, that could be perceived as murder. I don’t think that’s what’s going to happen here.

I think what is going to happen is she’s suffering from getting off the ventilator. Many patients in ICU do suffer from that. With broken ribs, broken clavicle, fractured ankle, and a lot of pain patients generally speaking, are not going to die.

Now, you are saying she’s got alcoholic dementia as well. So, I don’t know whether she’s got any liver damage from that and potentially there could be complications from that if she is in liver failure.

However, if she is talking to you and she’s talking to them, that is a very good sign, and that also means she might be able to be talked through the extubation. So, what that means is when they take out the breathing tube.

Certain things need to happen before you can take out the breathing tube, the patient needs to be awake, needs to be able to obey single commands such as, can they squeeze your fingers, wiggle their toes? Have they passed the spontaneous breathing trials? Are the arterial blood gases within normal range? Do they have a good cough or gag reflex? Are they awake? And your sister is awake. So, that means if they take off sedation, hopefully, next time around they can talk her through the extubation process.

Now, if she’s got dementia, that might throw a spanner in the works, but it sounds to me like she’s talking to you appropriately. That is a good sign. The question here also is, is she potentially going through withdrawal?

Again, if she’s potentially alcohol dependent, is she going through alcohol withdrawal while she’s in ICU? If so, what are they doing about it? Is that part of the issue why she’s not waking up and why she can’t be weaned off the ventilator?  Have they made her potentially too drowsy to wean her off the alcohol as well?

So, for example, what I’ve seen with patients that go through withdrawal in ICU while they’re on a ventilator and they go through substance withdrawal, whether it’s alcohol or drugs or any other medication, you often need to counteract that with other medications such as sometimes Diazepam or Benzodiazepines, which then delays waking up.

So, that’s why it’s so important in a situation like that, that you do get a second opinion and that you also exercise your rights about. If you are the next of kin, they can’t just let your sister pass away without your consent, assuming there is no advanced care plan where your sister would say, “Oh, she wants to die.” If you’re letting someone die that can say to you, they want to live. Well, again, I argue that would be perceived as murder. So, they have to put the brakes on, and they have to make sure they’re doing all the right things.

So, it’s very important that you get a second opinion. It’s very important that you have an advocate speak to them directly, which is what we do here at intensivecarehotline.com. It’s very important that you have myself or my team look over the medical records, making sure they’re doing all the right things, looking at blood results, looking at an arterial blood results, looking at what ventilator settings she’s on. It’s also very important in a situation like that and looking what medication she’s on. Really, really important in a situation like that.

If they still want to “kill” your sister, that would just be wrong. Like I said, the best way is to give me a call on one of the numbers on the top of our website at intensivecarehotline.com, and then I can deal with this pretty quickly. We have saved many lives in similar situations before.

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’ve been saving many lives as part of our consulting and advocacy. You can verify that if you go to intensivecarehotline.com, if you call us on one of the numbers on the top of our website, or then if you simply send us an email to [email protected].

You can get access to the membership by going to intensivecarehotline.com by clicking on the membership link or by going 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 addressing many of the challenges you and your family are facing. I have personally written and recorded those e-books and videos, and you will get access if you’re a member.

I also do one-on-one consulting and advocacy with you and your family over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I handhold you through this once in a lifetime situation that you can’t afford to get wrong. I also talk to doctors and nurses directly on your behalf if that’s what you want me to do. 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, always making sure that you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment while they are critically ill in intensive care.

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 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 send us an email to [email protected].

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, share this video with your friends and families.

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 YouTube channel, or if you are a subscriber to our email newsletter at intensivecarehotline.com and you can subscribe there.

If you want your video and questions answered quickly, leave a small donation on the super chat button on YouTube. I have so many emails sitting in my inbox from last year and I can barely keep up with making videos, but if you want yours answered, leave a donation and I will read it out and answer it as quickly as possible. Also, if you want to leave a small donation in any way, it will help us to make as many videos as possible and help as many families in intensive care as possible.

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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