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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 a question from Mark who says, “My dad is ventilated in intensive care. He’s got high blood pressure when he’s being weaned off the ventilator. Therefore, they can’t extubate him. Extubation is the removal of the breathing tube. What should we do?”

Great question, Mark.

I’ve seen this dozens of times, hundreds of times. I’ve worked in critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years in intensive care. We’ve been consulting and advocating for families in intensive care here at intensivecarehotline.com since 2013.

It is very fair to say that we have saved many, many lives here with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com or on our podcast section where we’ve done some client interviews.

Coming back to Mark’s question. So, when someone is waking up from an induced coma and their blood pressure shoots up, it is often a sign of distress. It is often a sign of confusion, agitation. So, imagine this, if someone is in an induced coma like your dad, they’ve been “asleep” chemically, kept asleep. Then they’re waking up, they have no recollection of what’s happened. They have no recollection of where they are, why they are in intensive care. Someone might explain it to them. But they can’t talk because of the breathing tube. So, it is an extremely distressing situation.

Now, the issue here is that the longer someone stays in an induced coma, the more deconditioning there is, and the more time patients need to spend to rehabilitate, to get their energy back, get their strength back and so forth. So, minimizing the time someone is being kept on the ventilator is on the one hand, very important.

On the other hand, it’s also important making sure that patients can deal with their critical illness. Sometimes that means the patient needs to stay in an induced coma for a little bit longer so they can fight their critical illness.

Now, if your dad is already strong enough and he’s breathing by himself and he’s obeying commands, but his blood pressure is shooting up, it’s most likely a sign of discomfort. If he’s strong enough to breathe, if he’s strong enough to cough, if he’s obeying commands, his blood gases are good, there’s minimal secretions, then he should be extubated, and you will find that his blood pressure will go down.

I’ve seen it many, many times where the cause of distress and high blood pressure is simply the breathing tube. It is extremely uncomfortable having the breathing tube in your throat, cuffed with a balloon, and air is being forced into someone. That’s all well and good if someone needs an induced coma, but your dad might be ready. That part, I don’t know.

But if his blood pressure is high, it’s a very good chance, it is simply distress, it is pain, it’s discomfort. By taking the breathing tube out, you’re eliminating that part of stress. Once again, your dad needs to be awake. He needs to have passed the spontaneous breathing trials. He needs to be off sedation and opiates. His arterial blood gas needs to be within normal limits. His chest x-ray needs to be clear. I have written an article, “How to wean a critically ill patient off the ventilator and the breathing tube?” that I will point towards below this video in the written version of this blog. You can read there what boxes need to be ticked before you can extubate someone.

But most of the time, also, if your dad has a brain injury and can’t control his brain and he’s not able to obey commands, he might not be able to swallow. Then taking out the breathing tube might be too risky.

Nevertheless, if he’s got a brain injury and the breathing tube is troublesome for him and that’s causing the high blood pressure, then he might need a tracheostomy. A tracheostomy is nowhere near as uncomfortable as a breathing tube in the throat. So, I hope that answers your question, Mark, of what the next steps are here, and you know what to do next.

But the best-case scenario here is take the breathing tube out and your dad’s blood pressure will go back to normal. Even if he does need a tracheostomy, and if he can’t breathe, if he can’t obey commands, best case scenario would be a tracheostomy. He can tolerate that much easier, and his blood pressure might also go down.

Now, on the other hand, if it is a real blood pressure issue and it’s got nothing to do with the breathing tube or discomfort, he probably needs to be seen by a cardiologist and his medication might need to be optimized. That is another option here as well.

So, is he on antihypertensives like anti-high blood pressure medications? It’s also a question you need to ask, he might need to be reviewed by a cardiologist. Also, if he does have ongoing high blood pressure, there’s also a much higher risk of a stroke. So, please ask all those questions. So, I hope that answers your question for today.

Because we get so many questions from families in intensive care, that’s why we created a membership for families of critically ill patients in intensive care. You can become a member if you go 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, and we answer all questions, intensive care related.

In the membership, you also have exclusive access to 21 e-books and 21 videos where I share all of my decades worth of intensive care nursing experience. Those e-books and videos, plus, the access to me and my team will help you to make informed decisions, have peace of mind, control, power, and influence.

I also offer one-on-one consulting and advocacy over the phone, Skype Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this process, making sure you stay two steps ahead of the intensive care team, so you manage them, and they don’t manage you. I also talk to doctors and nurses directly and 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. All with the goal of you making informed decisions, having peace of mind, control, power, and influence, making sure your loved one gets best care and treatment. 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 offer 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] 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, 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 get notification if you are a subscriber to my YouTube channel or if you are a subscriber to our email newsletter at intensivecarehotline.com. Also, comment below what you want to see next, what questions and insights you have.

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.