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

So, I’ve got this email from a reader who says, “The doctors are saying my 79-year-old mother needs a tracheostomy, but they cannot keep intubation in her after 14 days. She has a neck injury they found in an MRI (Magnetic Resonance Imaging) scan, and they won’t send her to the Medical Center for surgery because there are no beds. She has been in hospital for three and a half months and was left off liquids and not being fed by nurses. She had to have emergency dialysis and is fully awake and answering questions for the last five days or so. Her partial pressure of carbon dioxide (PCO2) level was at 98 millimeter per mercury before they sent her to ICU, when I found her almost dead in her hospital room on October 29, 2022. She’s fully alert but cannot speak or write due to weakness in her arms. An intravenous (IV) cannula was put into her arms and swelled severely. Now, her skin tears easily. What should I do? I don’t want her to have a tracheostomy.” Okay, great question to ask.

The first thing that always needs to happen in a situation like this is, an ICU needs to do whatever’s within their power and whatever it takes to get someone off the ventilator with a breathing tube and to avoid a tracheostomy. It sounds to me like you don’t have a good understanding of the steps that need to take place when someone needs to be extubated or be weaned off the ventilator and perform a tracheostomy. The question should not be “Does your mom need a tracheostomy after 14 days?” The question should be, “Has the ICU team done everything beyond the shadow of a doubt and within their power to wean your mom off the ventilator?” Especially now, that you’re telling me she’s awake. Questions are, what’s her carbon dioxide (CO2) level doing now? What’s her partial pressure of oxygen (PO2) level doing now? Is she still on sedation? Is she still on fentanyl? Is she on morphine? Is she still on sedatives? What ventilation settings is she on? What do chest x-rays show like? What are arterial blood gases like?

So again, it comes back to that the biggest challenge for families in intensive care is simply 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. And that is one of your challenges here, because again, the question should not be, “Should my mom have a tracheostomy after 14 days?” The question should be, “Has the intensive care team done everything beyond the shadow of a doubt to get your mom off the ventilator?” And I have made an article and a video about that, that I will post below this video so you can actually see what needs to happen to wean your mom off the ventilator.

As it relates to the IV that was put in her arms, she should probably have a central line while she’s in ICU or a peripherally inserted central catheter (PICC) line. Why don’t you ask for that? And they should avoid the IV cannula in her arm, assuming she has a peripherally inserted central catheter (PICC) line or a central line, which is often first choice in ICU.

So, that is my quick tip for today.

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 in our membership area and via email, and we answer your questions, 24 hours a day.

Also, if you need a medical record review, contact us at intensivecarehotline.com as well. We can help you reviewing your loved one’s medical records while they are in ICU or after ICU, especially if you suspect medical negligence.

Thank you so much for watching.

I would appreciate if you subscribe to my YouTube channel, share this 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’ll talk to you in a few days.