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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 about how long should the patients stay in ICU when they are on BIPAP (Bi-level Positive Airway Pressure)? I can give you a real-world example today.

We’re currently working with a client who has their dad in ICU and he’s on BIPAP for respiratory failure type 2 i.e. for CO2 (carbon dioxide) retention and they found that by putting him on BIPAP and by getting his CO2 down, he’s actually improving. Now, ICU wanted to send him out to a hospital ward and initially the family hadn’t done their research. So, they let their dad leave ICU, go to a ward, and then it only turned out that he bounced back within less than 24 hours to ICU because his CO2 was rising because they could not manage the BIPAP on the ward.

Now, no surprise to me, I have worked in critical care for nearly 25 years in three different countries where I worked as a nurse manager for over 5 years and where I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can confidently and without any exaggeration say that we have saved many lives for our clients in ICU. You can verify that if you go to our testimonial section at intensivecarehotline.com, or if you go to our podcast section at intensivecarehotline.com where we have done some client interviews that can verify and vouch for the work that we are doing and have done.

So, coming back to our example today, can you basically go to a hospital floor or hospital ward on BIPAP? The short answer is no, because it is an intensive care skill to keep someone on BIPAP for CO2 retention and get the CO2 down by keeping them on BIPAP for as long as it takes, to monitor arterial blood gases, to monitor chest X-ray, to also make sure that patients are eating and drinking adequately or getting nutrition adequately, and sometimes that might be via TPN (Total Parenteral Nutrition). Because if they’re on BIPAP and they may have too much air and oxygen going into the stomach. Therefore, they are at risk of aspiration which puts them at risk of intubation, so that patients need to go on a ventilator with an intubation tube.

With Intensive Care at Home, I’m jumping a little bit here when I say the same goes with Intensive Care at Home. Some of you know that we are also doing Intensive Care at Home nursing. When you are at home with BIPAP for CO2 retention, you also need an intensive care nurse for 24 hours a day, and that is documented in the Mechanical Home Ventilation Guidelines that you can look up at intensivecareathome.com and I will link towards it below this video.

So, the bottom line is, if someone is on BIPAP for CO2 retention and they’re getting drowsy if CO2 is rising, they cannot go to a hospital floor. There might be the exception if it is like a high dependency unit or a very good respiratory ward or pulmonology ward. There might be the exception where on some of those hospitals, they can look after BIPAP, but that is the exception and not the rule. I argue most hospitals in English speaking countries do not have the capacity and the skill outside of ICU to manage BIPAP for a patient that is entitled to respiratory failure with CO2 retention. So, keep that in mind.

So, the client we’re working with is basically asking us, “Well, how can we keep advocating for our dad so that he doesn’t go to the floor again until they have his CO2 under control?” And clearly, what we are doing here now is looking at the medical records. By looking at the medical records, we’re looking at arterial blood gas, at chest X-rays and medications that is on, and ventilator settings, of course. That’s how we can find out what to write to the hospital so that their dad can stay in ICU because you will need that crucial advocacy in a situation like that.

If you’re not having the advocacy, hospitals will try and walk all over you, quite frankly. If you don’t have anyone standing up for your loved one, they certainly will do what’s in the best interest of the hospital and they won’t do what’s in the best interest for your loved one. We’ve seen that over and over and over and over again. So, by having a second pair of eyes coming in, by speaking the clinical language, by doing the advocacy for your loved one, that’s when things will change. Again, you can verify that in our testimonial section.

So, on a hospital floor or a hospital ward where there are no ICU nurses, they simply can’t manage BIPAP for CO2 retention, that is as simple as that. You need to know when to put on the BIPAP, when to take it off, you need to know what to monitor, what you monitor in terms of arterial blood gases and so forth, in terms of patients conscious level. It’s going to be a disaster if your loved one leaves intensive care too early or whether they can leave intensive care at all. It’s a fine line that needs to be managed and monitored in a situation like that. If they can’t go, if they can’t leave intensive care, the bottom line is that the best option then is to use Intensive Care at Home. It’s also the best option for the hospital because they will be saving a lot of money and they can free up an ICU bed.

So I hope that helps you understand what we’re going to do here with our advocacy and what you need to do if you have a family member in intensive care on BIPAP, for example.

Now, because we get so many questions for families in intensive care here at intensivecarehotline.com, that’s why we created a membership for families of critically ill patients in intensive care and you can become a member if you go to intensivecarehotline.com, you click on the membership link or you go 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 me and my team. You also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. All of this exclusive information will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment and so that you can influence decision-making fast.  That is also very important when you have a loved one critically ill in intensive care.

I also do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, Skype, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly. I also represent you in family meetings with intensive care teams. I handhold you through this once in a lifetime process and situation that you simply can’t afford to get wrong when you have a loved one in intensive care. When I talk to doctors and nurses directly, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one 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 the intensivecarehotline.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 in intensive care. Click the like button, click the notification bell, and comment below what you want to see next, what questions and insights you have.

I also do a weekly YouTube live where I answer your questions live on the show and 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. Share the video with your friends and families as well.

If you want your email read out quickly here and get an answer quickly, I encourage you to do a small donation with the YouTube super chat button and I will get to your video as quickly as possible. I have so many emails sitting in my inbox, I’m barely keeping up with making all these videos. Leave a small donation anyway, if you want to support our work.

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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