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

So, today’s tip is answering a question from another reader who says, “My mom is in ICU and BIPAP (bilevel positive airway pressure) and her CO2 (carbon dioxide) level is 55. And she’s lethargic and sleeping all of the time. She wakes up occasionally when spoken to. What should I be looking out for, especially in view of getting rid of the BIPAP?” Well, that’s a fantastic question and I’m glad you’re asking it.

So, when patients are in ICU on BiPAP, it’s often a sign of respiratory failure or it can be a sign of Type 2 respiratory failure. So, Type 1 respiratory failure is low oxygen levels and Type 2 respiratory failure is high CO2 levels. And it sounds like your mom might have type two respiratory failure of unknown cause. You haven’t shared whether she’s got a history of COPD (chronic obstructive pulmonary disease), whether she’s got history of asthma, whether maybe she overdosed on some opiates. You haven’t shared any of that.

But the reality is that if CO2 levels are high around 55 millimeter per mercury that she might be drowsy. Normal CO2 levels are 35 to 45 millimeter per mercury, and 55 is too high. Some patients with COPD or asthma have a high baseline, i.e., their CO2 level is higher to begin with. They might start their baseline CO2 might be around 50 but given that your mom is sleepy, she probably has a normal CO2 baseline.

The other thing that you got to look out for is, is she on opiates such as morphine, fentanyl? Is she having any other sedatives? Is that potentially a reason for her sleepiness? Because if she has a high baseline CO2, it could as well be the medications that she’s getting that’s making her sleepy because her CO2 might be high to begin with. Those are questions you should be asking.

Now, other things to get CO2 down, let’s assume your mom doesn’t have a high baseline CO2. Let’s just say your mom’s CO2 baseline is normal. Why is it so high? You should be looking out for how much BIPAP are they giving her. What’s her PEEP (positive end expiratory pressure)? What’s her pressure support? And if CO2 is too high, maybe they need to increase PEEP and pressure support to get CO2 down. But also, as I said, maybe they need to stop any opiates that she may or may not be getting. Any sedatives that she may or may not be getting.

So, other things that should happen if your mom is awake is physical therapy or physiotherapy and breathing exercises. Ideally, mobilization should happen. Other things you need to look out for when someone is on BIPAP is aspiration risk. So, if your mom is drowsy, she might have a nasogastric tube to get feeds and nutrition through the nasogastric tube and if she’s drowsy, there’s definitely an aspiration risk as well. Now, the last thing that you want for your mom is that she’s aspirating when she’s on BIPAP because the next step there is often that patients are going to be intubated or have the breathing tube inserted and be put on a ventilator and go into an induced coma. And that is not what you would want for your mom.

Next, you should be looking out for a chest x-ray results, of course. You should be looking out for arterial blood gases. We know that CO2 is around 55 millimeter per mercury, but what’s PO2 (partial pressure of oxygen), for example? And then in order to get CO2 down, again, PEEP and pressure support probably need to be increased. Hopefully, they’re not very high to begin with so that there’s room to move. Again, if there’s no room to move, they probably will start thinking about intubating your mom and that wouldn’t be good. You got to keep your mom off the ventilator with the breathing tube if you can.

Other things you should be looking for is, is she continuously dependent on the BIPAP? Or can she have time off the BIPAP? So, for example, can she have two hours on the BIPAP, two hours off the BIPAP? So, you’re talking about a CO2 or 55 millimeter per mercury. When is that being measured? Is that being measured while she’s on BIPAP? Is that being measured while she’s off the BIPAP? You got to put things in perspective when it comes to CO2 levels whilst on BIPAP.

So, I hope that helps to answer your questions around BIPAP for your mom in our ICU.

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].

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, and we answer all questions intensive care related.

Also, if you need a medical record review for your loved one in intensive care or after intensive care, especially if you suspect medical negligence or if you just simply need medical information translated into normal language, we can help you with that by reviewing medical records. Please contact us as well.

Subscribe to my YouTube channel for regular updates for families in intensive care, share the video with your friends and families, click the like button, click the notification bell, and comment below what you want to see next, or what questions and insights you have from this video.

Thanks for watching.

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