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

So, I had an email from Stacy who says,

“My mom is in ICU. They say my mom can’t breathe on her own, but she’s sitting up and she takes breaths on her own. They say it isn’t enough. Can you give me more information what that means?”

Well, you’ve heard me say before, the biggest challenge for families in intensive care is simply 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.

And it also tells me that (A) you’re not asking the right questions or (B) you’re dealing with an intensive care team that is not prepared to go the extra mile and explain things in detail to you. So, first off, I don’t know whether your mom is having a breathing tube in her throat or whether she’s having a tracheostomy. You haven’t shared that. But let’s just go through both scenarios.

Let’s just say, she sits up and takes breaths on her own, but let’s say it’s not enough. Let’s just say she has a breathing tube. What that probably means is they’re doing a spontaneous breathing trial, CPAP, or pressure support, but either her pressure support or PEEP is still too high that she can’t be extubated.

Pressure support, generally speaking, needs to be below 10 and PEEP needs to be below 7, ideally around 5. But also then, the volumes that your mom is breathing need to be adequate to her weight. And a good rule of thumb is 7 to 10 mls per kilo. That’s what the volume should be like.

Another measure that should be put in place here is what arterial blood gas is like. If she’s breathing on CPAP pressure support and maybe her volumes are fine, maybe pressure support is still too high, what do blood gases show? What does the chest X-ray show? That is most likely what’s happening here.

Also, what’s the breathing rate like. Is she breathing too fast? Is she breathing too shallow? And it’s the same if she’s on a tracheostomy. Is she not coming down on her support levels, i.e., pressure support, but also FIO2, the oxygen that’s being given, room air is 21% oxygen. The ventilator can give up to 100% oxygen. Is she getting 40% oxygen? Is she getting 60% oxygen? If she’s not below 40% of FIO2, it is very unlikely she can be weaned off the ventilator.

Also, what you’re not saying is, is she awake? Is your mom awake? Your mom needs to be awake to have the breathing tube removed. She needs to be able to obey commands. It’s different from the tracheostomy. She can be taken off the ventilator with the tracheostomy even if she’s not obeying commands. The devil is in the detail.

So, I really hope that helps you explain that in the summary. It comes down, can she be weaned of pressure support, PEEP, FIO2 – the oxygen delivered? Are her tidal volumes, the volumes that she’s breathing in and out, are they adequate for her weight, 7 to 10 mls per kilo? What are arterial blood gases like? Can she obey commands? What do chest x rays show? Is her breathing rate within normal limits? Not too fast, not too slow. If she’s getting exhausted too quickly during the spontaneous breathing trial, she won’t be able to be weaned off the ventilator.

And then the next question is, how can that be optimized? Is she still confused for example, many patients after an induced coma are confused. Does she need to get out of a delirium induced coma? She needs help with that. Do they need to change medication? Do they need to stop certain medications? Would mobilization help? Would getting her into a shower help with a shower trolley? All these questions need to be asked. Does physical therapy help with breathing exercises, coughing exercises? Those are the things that need to happen.

Now, I will post a link below to a video that I’ve done a while ago. It says, “How to wean a critically ill patient off the ventilator and the breathing tube?” And there’s more information in there. I hope that helps.

Thank you so much for watching.

We have a membership for families of critically ill patients in intensive care where we answer your questions, and you can get access to the membership for families of critically ill patients at 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. I also offer one on one consulting and advocacy for families in intensive care. I talk to you and your families directly, but I also talked to doctors and nurses directly. And I ask all the questions you haven’t even considered asking but must be asked so that you make informed decisions, have peace of mind, control, power and influence.

And when I talk to doctors and nurses directly, they will very quickly realize that you have someone on your team that understands intensive care inside out, and that will change all the dynamics. You have to know what to look for, and you have to know what questions need to be asked.

I have worked in intensive care for over 20 years in three different countries where I also worked as a nurse manager for over five years. And I have been consulting and advocating for families in intensive care for over 10 years here at intensivecarehotline.com. And you can look up our testimonials on our testimonial section. There’s also podcasts on our website where I have done client interviews vouching for the results that we’re getting here.

I also represent you in family meetings with intensive care teams, so once again that you know what to say, how to say it. And I also assess with you whether you should even go to a family meeting. Very important for you to assess whether you should go into a family meeting or not because you might be digging your own grave quite literally if you do go into a family meeting sometimes.

We also offer medical record reviews in real time. And give you 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 simply suspecting medical negligence.

Now, if you like my video, 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.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.