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 I have an email from Charles says, 

“Hi Patrik,

My sister has been in ICU for three weeks, treated for almost every organ, dialysis, lungs, heart etc. She suffered a stroke and a massive cardiac arrest while in ICU and after the induced coma was removed, she couldn’t wake up. They performed a brain scan and found that her brain was swelling. Now, they have informed the family that medically, there’s nothing they can do. They took her off everything except the ventilator. How long will she still be alive and does the ventilator do any good?”

Well, thanks Charles for writing in. Now, the question is, how many days has she been out of the induced coma before a judgment has been made that she can’t wake up after the induced coma? Has it been 24 hours? Has it been 48 hours? Has it been a week? Has it been two weeks? Just because she couldn’t wake up so far, doesn’t mean she can’t wake up or she will never wake up.

Now, if the brain is swelling, why is the brain swelling? Have you asked the neurologist? If they’re telling you that medically, there’s nothing they can do besides keeping her on the ventilator, again, I question that. Why is she not waking up? Has she had too many sedatives? How bad is the brain scan? Is there a hypoxic or an anoxic brain injury? Has there been something else? Has she been on high amounts of sedatives or opiates? Is that why she’s not waking up? Has she been chemically paralyzed, which also often delays waking up? Have you spoken to a neurologist? Are the kidneys failing? Is the liver failing? Because if kidneys and liver are failing, what that means is she may not have metabolized or excreted all sedatives and opiates which may also delay waking up.

Next, does she have seizures? If she’s having seizures, are they giving her anti-seizure medications? Also potentially delaying waking up.

Now, you are saying she’s on a ventilator. How long will she still be alive and does the ventilator do any good? You want to minimize mechanical ventilation ideally as quickly as possible. The question here is, how long has she been on the ventilator for? Does she have a tracheostomy? Is she getting physical therapy? Is she getting mobilized? Because if she’s, for example, on a ventilator with a breathing tube, mobilization is not impossible, but much harder. If she’s ventilated with the tracheostomy, mobilization and physical therapy is much easier, it’s less risky.

How long will she still be alive? Well, if patients are hemodynamically stable and their vital signs are stable, you can keep them alive hemodynamically for a long time. If their other organs are fine, you can keep people alive potentially days, weeks, years, sometimes decades. Is the ventilator doing any good? It depends from which perspective you see it. It keeps people alive. 

Question is what’s the quality of life for your sister? Whilst it may not be good today, is the quality of life improving in the next few weeks, months. Nobody knows until you try and until you give it your best shot. You’re also saying they have treated her for almost every organ, dialysis, lungs, heart, etc. So, if she had dialysis, why did they stop doing dialysis? Are the kidneys not recovering? Does she need to go back on dialysis?

So, what I would highly recommend here, Charles, is that get to have a look at the medical records, or I talk to the doctors and nurses directly because depending on what they say, I will have follow up questions. What ventilator settings is she on? Is she coming close to getting off the ventilator? Is that realistic? What’s her Glasgow coma scale like? Glasgow coma scale is a neurological assessment tool to ascertain what neurological function is present for a patient that will help determine what the future outlook might be. Also, if the brain is swelling, have they given diuretics like such as mannitol, for example? So, there’s a number of questions here that need to be answered.

Also, you’re worried how long could she be alive on a ventilator? Like I said, if all other organs are fine and she’s hemodynamically stable, she could be alive on a ventilator for a long time to come and then you may want to consider a tracheostomy to buy her time to recover because she can’t be on a ventilator with the breathing tube for more than 10 to 14 days. You’re already talking about that she’s been there for three weeks. You should be moving towards the tracheostomy pretty quickly if you want to give your sister a chance and if you want her to give her a chance for rehabilitation. If you stop everything, you know the outcome. If you continue treating, you will give her a chance.

Next, also consider options such as Intensive Care at Home. If she’s not waking up, but she needs to be ventilated, she has a tracheostomy, consider Intensive Care at Home, have a look at intensivecareathome.com. Charles, three weeks in ICU is not a long time. I know it feels like an eternity for you and your family, but it’s not a long time.

So, I hope that helps and explains what you should be looking for. Get a tracheostomy done to buy your sister time. If you don’t want a tracheostomy done, you want to withdraw life support, you know the outcome. If you do a tracheostomy and you give her time, you don’t know the outcome, but you’re giving her a chance. Don’t make decisions today that you may regret in 12 months’ time, always think ahead. Don’t make an emotional decision, make a rational decision. So, I hope that helps.

I’ve 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 say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com. You can also verify it on our podcast section at intensivecarehotline.com where we’ve done multiple client interviews. 

That’s one of the many reasons why we created a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com if you click on the membership link 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. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded to help you to make informed decisions, have peace of mind, control, power, influence so that you can influence decision making fast making sure your loved one gets best care and treatment. We have helped hundreds of clients and members over the years and like I said, we have saved many lives.

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 can’t afford to get wrong. I also talk to doctors and nurses directly and 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.

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 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, and share the video with your friends and families.

I also do a weekly YouTube live and you will get notification for the YouTube live if you are a subscriber to my YouTube channel or if you are a subscriber to my email newsletter at intensivecarehotline.com and on the YouTube live, I will answer your questions live on the show.

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.

Related Articles:

Quick Tip for Families in Intensive care: Is Ventilation Necessary After Tracheostomy? Quick Tip for Families in ICU: Should I Let Go of my Dad with Cancer on a Ventilator & Tracheostomy? Quick Tip for Families in ICU: 3 Things You Need to Pay Attention to for COVID ARDS in ICU! Quick Tip for Families in ICU: How to Get Information in ICU Fast! Quick Tip for Families in ICU: What is Considered Progress While Ventilated with a Breathing Tube?