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

So today, I have an email from Diane who says,

“Hi Patrik,

The doctors are just riding off my husband because of his previous stroke and his bleeding history, which was caused by a hospital anesthesia error by the way, which due to lack of therapy has left him immobile requiring 24-hour care. Although he is immobile, I feel that he is immobile due to lack of therapy as opposed to being immobile because his brain is not functioning properly.

After two days in ICU where they ventilated him on arrival because they said he wasn’t breathing on his own. Although prior to his ambulance ride, when he vomited again, his pulse oxygen was between 89% to 92%. So, I assume more vomit went into his lungs as he had pneumonia, which they are treating.

They are recommending a tracheostomy before knowing if he will be able to breathe on his own once the pneumonia resolves and before the blood from the bleed is reabsorbed when they could fully access his body’s abilities to function properly.”

So, this is from Diane. Thank you so much Diane for writing in. I think you’re making some extremely valuable points here that are very important for anyone watching this video or reading the blog.

I could not agree more with you that it’s potentially a combination of him not receiving physical therapy and him being in an induced coma while he is immobile, it is often a combination of both. It is often also a result of keeping patients in induced comas for too long.

I encourage you to reach out to one of my colleagues, Kali Dayton, who has a very interesting podcast and also very interesting website, Dayton ICU Consulting. I’ve had Kali Dayton on my podcast here and I’ve been on Kali Dayton’s podcast and she’s talking about that many patients in ICU do not need any sedation at all. I agree with her, and she has published a lot of great videos and podcasts on her website. Check out daytonicuconsulting.com. Like I said, I’ve also had her on my podcast, check out the intensivecarehotline.com podcast here.

Now, coming back to Diane’s email. So, the longer you keep someone sedated and in an induced coma, the higher chances there’s a delay in waking up, there’s a delay in getting physical therapy, there’s a delay in getting mobilized and that is a vicious cycle leading patients to be more and more ventilator dependent.

Of course, then the ICU team say, “Well, the patient needs a tracheostomy?” whilst they are avoiding to answer the question, what have they done to avoid the tracheostomy beyond the shadow of a doubt. What are they doing to wean your critically loved one off the ventilator beyond the shadow of a doubt?

I have written an article and made a video about, “How to wean a critically ill patient off the ventilator and the breathing tube?” I encourage you to check out that video or read the blog post because in there, I describe in much detail what needs to happen to get someone off the ventilator and the breathing tube and avoid the tracheostomy, which is critical.

You have to think about it. For someone to get off the ventilator, and the breathing tube, that’s a liberation. For someone to go from a breathing tube in the mouth to a tracheostomy in the neck is not a liberation. It’s continuing mechanical ventilation and life support, and continuing the hospital journey.

Now, don’t get me wrong. There is a time and a place for a tracheostomy but from what I can read in your email, Diane, I don’t think they have tried hard enough to get your husband off the ventilator and the breathing tube.

That’s what it comes down to. I would want to know, have they stopped sedation? Have they stopped the opiates? Have they cleared the pneumonia? Which is also a very important question to answer. Have they cleared the pneumonia? Because once they’ve cleared the pneumonia, there should be no reason for the ICU team to not wake your husband up and get him off the sedatives, get him off the opiates, get him off that ventilator. That is critically important as the next step, start physical therapy, start mobilization. That is the much better option than doing a tracheostomy.

Of course, your husband needs to be hemodynamically stable. He can’t be on vasopressors, he can’t be on inotropes to mobilize him. There are some contraindications, but that’s where we can help you to give you that critical second opinion.

A lot of families in ICU, as a matter of fact, I believe 99% of families in ICU are completely flying blind. Completely flying blind. At least like Diane, she’s reaching out and she’s asking some very intelligent questions where I can break things down for Diane, but also highlight what else is missing. The devil is in the detail here.

What ventilator settings is your husband on? What are his arterial blood gases? What do chest X-rays show? Just to name a few questions.

The biggest challenge for families in intensive care is 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.

I have worked in critical care nursing for nearly 25 years in three different countries where I worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com.

I can confidently and without the slightest hint of exaggeration, say that we have saved many lives with our consulting advocacy. You can verify that on our testimonial section. You can also verify it on our intensivecarehotline.com podcast section where we’ve done client interviews.

That’s also one of the reasons why we’ve opened the membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com and you click on the membership link or you go to intensivecaresupport.org. In the membership, you have access to me and my team, 24 hours a day, in a 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 have personally written and recorded, sharing all my decades worth of intensive care nursing experience. So, making sure that you make informed decisions, have peace of mind, control, power, influence so that your loved one gets best care and treatment and so that you can influence decision making fast.

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 handhold you through this once in a lifetime situation that you simply can’t afford to get wrong. I also talk to doctors and nurses directly. 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 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 from this video.

I also do a weekly YouTube live where I answer your questions live on a show. 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.

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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Quick Tip for Families in ICU: When Is a Tracheostomy Inevitable? Quick Tip for Families in Intensive Care: COVID-19 and ARDS, When is ECMO an Option? Quick Tip for Families in Intensive Care: What Can Happen If You Place a Person on a Ventilator Too Soon or Before it’s Critically Needed? Quick Tip for Families in ICU: Why There Can Be Delays with a Tracheostomy with COVID-19 Patient in ICU? Quick Tip for Families in ICU: Is My Dad Really in Multi Organ Failure in ICU? Can He Survive?