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

Today, I have a question from one of our clients, David, who says, 

“Hi Patrik,

My mother is in ICU and she’s starting to get stronger and more aware, but doctors used her sedation and said for her swelling to go down but the last CT scan was on August the 8th and it’s been a week and two days and she’s breathing on her own, but she does have COPD (Chronic Obstructive Pulmonary Disease) and they’re saying they don’t want to take the tube out yet. They want to do a tracheostomy but not giving her a chance to see if she can breathe without it. 

What do I do to give her body time to heal without getting a tracheostomy?”

Now, this particular client also had a history of UTI (Urinary Tract Infection), COPD, cirrhosis of the liver with high ammonium levels. Therefore, she was on lactulose regularly. She was also partly confused because of the high ammonium levels. She also had a brain hemorrhage and also had some seizures.

I know the situation very well because we worked with this client very closely. Here is what we recommended at the time. What we recommended was to get her ammonium levels down so that she can be more awake.

How can you get an ammonium level down when someone is in liver failure? You can get it down by giving lots of lactulose to increase bowel motions and increase the frequency of bowel motions, and therefore, ammonium is coming down, clearing up the brain for patients in ICU.

So then, what also should happen or needs to happen in a situation like that? Stop all sedation, stop all opiates, and see whether a patient can wake up. You see the issue is and this is a client in the U.S. The issue in the U.S. is, there is nowadays a lot of complacency in ICU instead of weaning someone off the ventilator and the breathing tube, which is often an art rather than a science. 

They’re moving towards the tracheostomy and the PEG (Percutaneous Endoscopic Gastrostomy) tube pretty quickly to then move patients out of ICU into LTAC, and that is a big challenge. No one should be having a tracheostomy prematurely or a PEG tube prematurely until a trial extubation has at least been done.

So, what does a trial extubation mean? It means you’re taking out the breathing tube, assuming someone is on the lowest ventilator settings, which means pressure support/CPAP (continuous positive airway pressure), PEEP (positive end expiratory pressure) of 5, FiO2 less than 35%, good tidal volumes, good minute volumes, normal arterial blood gases, patient is awake, can obey commands, can have a good cough, and gag reflex, can clear their throat, and secretions. That’s when you should do a trial extubation.

If patients then struggle, you could do high flow nasal prongs, you could do BIPAP or CPAP noninvasively. Again, if all of that fails, you can then reintubate and do a tracheostomy but not giving it a go without optimizing care and treatment is not appropriate, really.

So, in this situation, the client eventually did end up with a tracheostomy but at least she had some time off the ventilator at the time. She then went downhill again. At the end of the day, you never know how a trajectory goes. By the same token, you have to give it a go. Many patients with our consultancy here, have managed to stay off the ventilator and avoid the tracheostomy but you’ve got to give it a go.

But you also need to have your loved one in a good ICU. Not many ICUs or some ICUs nowadays have a really low skill mix and skill level because many senior ICU nurses quite frankly have left the industry because they’ve been treated so badly. But one way or another, this is what needs to happen in a situation like that.

So, I hope that helps you understand.

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, and that’s exactly what you are dealing with here, what David has been dealing with.

We’ve helped hundreds of clients over the years and members, and we’ve gotten spectacular results for them. You can verify that on our testimonial section. I can confidently and without the slightest hint of exaggeration, say that we have saved many lives for our clients in ICU and our members. Again, you can verify that on our testimonial section or in our intensivecarehotline.com podcast section where we’ve done client interviews.

I have worked in critical care and 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 all around the world here at intensivecarehotline.com since 2013.

That’s why we created a membership for families of critically ill patients in intensive care. You can become a member and get advice from us in advocacy and consulting if you go to intensivecarehotline.com if you click on the membership link, or if you are 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 by 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, making sure you make informed decisions, you have peace of mind control, power, influence so that your loved one gets best care and treatment. 

I also do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly. 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, critically ill in intensive care. I also represent you in family meetings with intensive care teams. I handhold you through this once in a lifetime situation that you simply can’t afford to get wrong.

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 intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply 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 the 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 intensivecarehotline.com 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 Intensive Care: My Husband’s Back in ICU with a Fever and Infection, Was it Safe to Take Him Home with a Tracheostomy? Quick Tip for Families in Intensive Care: Testimonial from a Client, Why Not Giving Consent to a PEG (Percutaneous Endoscopic Gastrostomy) Tube Saved Her 83-Year-Old Dad’s Life! Quick Tip for Families in Intensive Care: Another Testimonial from a Very Happy Client! Thank You for Helping My Mom to Get Out of ICU Alive! Quick Tip for Families in Intensive Care: Mom’s in ICU with Septic Shock & Poor Prognosis, Is There an Ulterior Motive to Push Her Out of ICU? Quick Tip for Families in Intensive Care: My Brother Had a Cardiac Arrest with Loss of Oxygen to the Brain, He Hasn’t Woken Up for 14 Days, Help!