Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

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

So, today’s tip is about a question that we got from a reader, but it’s also a question that we, one way or another, get quite frequently. So, here is what Pamela is saying. She says, “My mom has been in intensive care for nine days. Initially, she went in with grand mal and tonic-clonic seizures. So, they put her in an induced coma and sedated her whilst treating the seizures. Now, nine days later, she’s awake, she’s out of the induced coma, she still has a breathing tube in place, and she’s awake. She can write coherently so she knows what’s going on. And the doctors and the nurses have confirmed that her brain is intact and whatever she’s writing or pointing out with the letter board makes sense. It’s showing signs that she’s coherent and oriented. Now, the ICU doctors are also telling Pamela that she’s not ready to be extubated or have the breathing tube removed and that she hasn’t passed the spontaneous breathing trials. And how can I say that this is accurate?” And that is always the biggest question in ICU.

How can you verify that what you are told is actually what’s happening? And it comes back to that 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.

So, look, what you need to look for is whether your mom is breathing spontaneously on CPAP or a pressure support ventilation mode. That’s one thing you need to look for. But even if she does breathe on that, what are her arterial blood gases showing? Next, what is her oxygen saturation like? Next, what are her tidal volumes like? Is she breathing enough volumes? Is she breathing between sort of 10 to 28, 30 breaths per minute? It shouldn’t be any higher or any lower than that. The tidal volumes that she’s breathing should be adequate according to her weight and tidal volumes are usually measured around 7 to 10 mls per kilo body weight.  Obviously, your mom seems to be awake. And I have written an article how to wean someone off a ventilator and a breathing tube, and I’ll link towards that article and video below this video so you can check out and make sure that she’s ticking all the boxes there.

But more importantly, it all comes down to asking the right questions, and it comes down to having a second opinion, which is what you’re doing here. You are trying to get a second opinion. Bear in mind, I am only having the limited information you’re giving me. And it would be very advantageous if we could (A), talk to the doctors and nurses directly, or (B), if we could look at medical records.

and look at ventilator settings, look at arterial blood gases, look at blood results, what else is going on?  Look at what medications is she still on. Is she still having anti-seizure medications, for example, such as phenytoin or Keppra? And is she therefore still slightly sedated even though she’s awake? But is that sedative effect potentially impacting on her not being able to breathe 100% independently? Those are all questions that need to be asked.

Other questions that should be asked, is she potentially having not excreted or metabolized all sedatives and opiates? Is she potentially in acute kidney failure or liver failure? And is she not metabolizing or excreting all sedatives and therefore still slightly impacted by being a little bit too drowsy and not strong enough to get off the ventilator and be extubated?

So, those are all questions that need to be answered as well as if she was to be extubated, is she potentially a high aspiration risk? If she’s a high aspiration risk, that might be another reason why they still want to keep her intubated. So many questions to be answered, but I hope I’ve given you the first steps to get your questions answered.

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, 24 hours a day, and we answer all questions intensive care related.

And if you need a medical record review while your loved one is in ICU in real time, please contact us as well. We review medical records in ICU in real time and also after intensive care, especially if you are looking for getting questions answered, if you’re looking for closure, or if you simply suspect medical negligence. But the best way for the best results and best outcomes is if we review medical records in real time while your loved one is in ICU, again, so that we can help you interpret clinical intensive care data in real time.

Subscribe to my YouTube channel for regular updates for families in intensive care, share the video with your friends and families, give the video a like, click the notification bell, and comment below what you want to see next, or what questions 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.