Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

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

So today, I have an email from Victoria who says, “My brother is in a on a ventilator in intensive care and he was breathing on his own for 5 hours and then became tachypneic. Should I consider putting him on a ventilator or CPAP support? Thank you.”

There’s a little bit of contradicting information there from Victoria. Again, I’ll read this out again. She says, “My brother is on a ventilator and was breathing on his own 5 hours and then became tachypneic. Should I consider putting him on a ventilator or CPAP support? Thank you.”

Tachypnea means breathing very fast. Now, if your brother is on a ventilator, is he on a ventilator with a breathing tube or is he on a ventilator with a tracheostomy? That’s the first distinguishing factor here.

Let’s assume I’ll go through both scenarios so you can understand what both scenarios look like. If your brother is on a ventilator with the breathing tube and he was breathing on his own for 5 hours, then became tachypneic, well, he stays on the ventilator because he was saying he’s on the ventilator already.

Should they CPAP (continuous positive airway pressure) him? Well, he is probably on CPAP already if he’s breathing on his own and he’s on a breathing tube. When someone is on a breathing tube and people are talking about their breathing on their own, they’re talking about him breathing on CPAP or pressure support.

So, if he’s tachypneic, breathing fast on the pressure support, put him back in a controlled mode like SIMV (synchronized intermittent mandatory ventilation) or ACV (assist controlled ventilation) and ventilate him until he can have another go at CPAP or pressure support. If he can’t manage that and it goes on for over two weeks, God forbid, then he will need a tracheostomy because he won’t be ready for extubation.

Let’s just run through the scenario where he has a tracheostomy in a situation like that. So, he’s on a ventilator and he was breathing on his own for 5 hours. Again, if he was breathing on CPAP and then he became tachypneic, should I consider putting him on the ventilator? Well, he’s already on the ventilator or a CPAP support. So, the only difference with a tracheostomy is if he’s on a tracheostomy and he’s breathing on his own, he might actually be breathing spontaneously, and they might have put him on a tracheostomy mask or tracheostomy collar.

Now, if he has 5 hours on a tracheostomy collar, for example, and he is breathing independently completely off the ventilator, should you consider putting him back on the ventilator with CPAP or pressure support or with an SIMV rate or an ACV rate where the ventilator is doing most of the breathing? Well, most of the time, you can try CPAP first, CPAP or pressure support. That might be enough to give him a rest, let him sleep overnight, or whatever the case may be and then try again in the morning. So, that is one way to handle it.

Now, if he’s really so exhausted after breathing spontaneously and he needs to be fully ventilated on SIMV or ACV where the ventilator is doing most of the work, then maybe in the morning, you can try CPAP again. When weaning someone off the ventilator is often trial and error and you got to go through the motions sometimes until you achieve your goal.

Now, another question here is regardless of whether your brother is on a ventilator with a breathing tube or with a tracheostomy, is he getting physical therapy? Is he getting mobilized? What are they doing to aid him getting off that ventilator? So, those are questions that you need to look for.

Also, on top of what I just explained, what are his arterial blood gases like? That is also a very good indicator on what needs to happen next. So, for example, he’s getting exhausted on the CPAP, and his blood gases are really poor, well, putting him back in an SIMV or an ACV mode where the ventilator is doing most of the breathing for your brother, his blood gases should improve and then same thing you can try again tomorrow. The blood gas will also give you an indication if you can have time off the ventilator again, if it can be extubated, if he has a breathing tube.

Also, how often does he need suctioning? How frequently does he need suctioning through the breathing tube or the tracheostomy tube? What does the chest X-ray look like? Does he have any chest issues besides being ventilated? So, those are the things that you should be looking for here, Victoria.

I have worked in critical care for nearly 25 years in three different countries and I have seen many of those situations whether with a breathing tube or with the tracheostomy. I’ve worked as a nurse manager for over 5 years in intensive care. We’ve been consulting and advocating for families in intensive care all over the world here at intensivecrehotline.com.

You can look up our testimonials at intensivecrehotline.com by going to our testimonial section and I can confidently say we have saved many lives with our consulting and advocacy by giving families a second opinion, by giving families a voice. You can also verify that on our podcast section where we’ve done some client interviews.

Also, that’s why we created a membership for families of critically ill patients in intensive care. You can also become a member at our membership at intensivecrehotline.com by clicking on the membership link or 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 that I personally have written and recorded, sharing all my experience in intensive care, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

Also, I offer and do one-on-one consulting and advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you, and I talk to you and your families directly, handholding you through this process in critical care, making sure you don’t get this once in a lifetime situation that you can’t afford to get wrong, making sure you get it right, and making sure you make informed decisions, have peace of mind, control, power, and influence.

I also talk to doctors and nurses directly with you and on your behalf. I ask all the questions 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.

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 intensivecrehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families with 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 the 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 sign up for my YouTube channel or if you sign up for our email newsletter at intensivecrehotline.com. You can also make a small donation or a big donation at the super chat button here on YouTube that helps us create more content, helping as many families as possible in intensive care all over the world.

Also, if you want your question answered quickly, just via video, and you make a small donation. I will read that pretty quickly. I have questions as far back as November, December last year. So, I’m not keeping up with videos even though I’m trying to do one every day.

Thank you so much for watching.

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

Take care for now.

Related Articles:

Quick Tip for Families in ICU: My Wife’s in ICU with Cardiac Arrest & Tracheostomy, Can I Make Decisions? Quick Tip for Families in Intensive Care: My 28-year-old Husband had a Liver Stab Wound & His Heart Stopped! ICU Wants to Stop Treatment, Help! Quick Tip for Families in ICU: 28 Days in a Medically Induced Coma & Breathing Tube Down the Throat, on the Ventilator. What’s Next? Quick Tip for Families in ICU: The 3 Biggest Myths in ICU Exposed for Families in Intensive Care! Quick Tip for Families in Intensive Care: My Dad’s at FiO2 (fraction of inspired oxygen) 30-40% and PEEP (positive end expiratory pressure) 5, Why are They Not Pushing for Spontaneous Breathing Trial?