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

So today I’ve got an email from Maureen who says, “My mom has been in intensive care for five days now and I am getting told she’s comfortable on the ventilator with a breathing tube, but she can’t be extubated. What does that mean? And what questions should I be asking?”

Well, that’s a great question Maureen. And I can picture what your mom is going through after having worked in intensive care for over 20 years in three different countries where I also worked as a nurse manager for over five years in intensive care. And I have been consulting and advocating for families in intensive care since 2013. It’s part of my intensivecarehotline.com consulting and advocacy service. And I have been advocating for families in intensive care all over the world. Have a look at our testimonial section and our podcast section where we have client testimonials and interviews.

So Maureen, what does that mean? What it probably means is, your mom is still on sedation. Probably a little bit of propofol or versed/midazolam or precedex. She’s probably also still on opiates such as morphine or fentanyl to keep her comfortable. The problem with sort of the situation is that, those medications will make her feel comfortable so that she can actually tolerate the breathing tube because it is very difficult to tolerate the breathing tube in your throat. And most patients can’t tolerate it without sedation and opiates. That means, she can’t be extubated

Now, it’s a bit of a catch 22, sedation and opiates need to be stopped. That could make her uncomfortable because of the difficulty of keeping a breathing tube in. And then she needs to do more work. She needs to breathe up. They need to change the ventilation settings from a controlled ventilation mode such as ACV or SIMV to a pressure support or a CPAP mode. And then when she passes the spontaneous breathing trials, and she’s breathing good volumes, she’s not breathing too fast; she’s not breathing too slow. Her arterial blood gases are good. She can obey commands, and she’s coughing. Chest X-ray looks good. And once again, arterial blood gases are within normal range. That’s when you can assess for removal of the breathing tube or extubation. It’s a bit of an art going from removing sedation and opiates to extubation.

And it takes a lot of skill and experience to achieve that because you have a limited window of opportunity where you can achieve that. You also want to make sure that once the breathing tube comes out that you’re not needing to put it back in, that could be very traumatic for your mom.

So she’s sort of what I referred to in the twilight zone. She’s comfortable, but she’s not ready to extubate because she needs to fully wake up. And needs to be educated through the process of what to do, and how to breathe. She might also need some physical therapy. She might need to do some breathing exercises, coughing exercises, and physical therapy, ideally sit on the edge of the bed. Ideally, sit in a chair. That can all be done.

A good ICU will sit her in a chair, even with a breathing tube. That’s assuming your mom doesn’t have any fractures. She’s not hemodynamically unstable, but it’s sort of a nurturing process to get patients from intubation, induced coma, then to extubation and the quicker it can be achieved, the better. No one wants to keep a patient intubated for too long because then other complications may arise such as ventilator-associated pneumonia, such as needing a tracheostomy. It’s critical that an ICU assesses this, every day, to avoid a tracheostomy to move a critically ill patient towards extubation as quickly as possible.

Now, I have made a video and written an article about, “How to wean a critically ill patient off the ventilator and the breathing tube?” that I will link to in this video below. And also in the article in the written version of this blog. And I encourage you to check that article and video out to understand more about the process.

So that is my quick tip for today, Maureen. I hope that helps.

Now, we have a membership for families of critically ill patients in intensive care that you can get access to and you can become a member at intensivecarehotline.com. If you click on the membership link there or if 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.

I also offer one on one consulting and advocacy for families in intensive care over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I talk to intensive care teams directly. I’ll set you up with questions to ask, but it’s much better if I ask them on your behalf because then I can have counter questions straight away.

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, and 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.

Now, when I talk to doctors and nurses directly with you, I ask all the questions that you haven’t even considered asking but must be asked so that you can make informed decisions, and have peace of mind, control, power and influence. We also offer medical record reviews in real time so that you can get a second opinion in real-time.

We’re finding over and over again that intensive care teams don’t even tell half of the story to families in intensive care unless you’re asking the right questions and unless you know what you need to look for. When a patient is in intensive care, there are dozens of things happening simultaneously and you need to look at all the things, whether it’s blood results, medications, or diagnostics, you need to look at everything and piece together what is a complex puzzle and only then can you make informed decisions, have peace of mind, control, power and influence.

I also represent you in family meetings with the intensive care team so that you have a strategy when going there. And we also assess whether you should even go into a family meeting in the first place. Probably something you haven’t even considered.

We also offer 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 simply suspecting medical negligence. All of this 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].

Now, 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, and share the video with your friends and family. Share it far and wide so that as many people can get educated when they have a loved one in intensive care.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.