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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 Matilda who says,

“Hi Patrik,

My son is on a ventilator in ICU but when he’s off, he will stop breathing, most likely within minutes. How long can he stay on a ventilator?”

From Matilda

That is a great question, Matilda, but it comes down to: Is he on a ventilator with a breathing tube in his throat or is he on a ventilator with a tube, a tracheostomy in his neck? So, the answer will depend on what sort of breathing arrangement he has.

So, let’s just run through if he has a breathing tube in his throat. If he has a breathing tube in his throat, he’s most likely in an induced coma on sedatives and opiates. Most commonly used sedatives are Propofol, Midazolam/Versed, or Precedex. Most commonly used opiates during an induced coma are morphine, fentanyl, sometimes Dilaudid or hydromorphone, and sometimes OxyContin. They’re sort of the most commonly used opiates when it comes to ventilation with the breathing tube and the induced coma that goes hand in hand. The reason for the induced coma is that very few patients can tolerate a breathing tube and the ventilator without being in an induced coma because it’s so uncomfortable.

So, if he stops breathing within a few minutes, the question is, does he stop breathing because (a) he can’t breathe for whatever reason, or (b) does he stop breathing because he’s on sedatives and opiates because they can cause stopping breathing as well, also known as apnea. So, that’s the first question.

The second question is, you haven’t shared why is your son in the ICU on a ventilator.  For example, does he have a C1 (Cervical 1) or C2 (Cervical 2) spinal injury? Then, he won’t be able to breathe even in the future. So, if he has a breathing tube, how long can he stay on a ventilator? Well, he can stay on the ventilator for maybe Day 10, or Day 14, and then he should have a tracheostomy, assuming he can’t be weaned off the ventilator, but I strongly recommend that the intensive care team tries to wean him off the ventilator. I’ve written an article and made a video about how to wean a critical patient off the ventilator and the breathing tube and I’ll link towards it, so I encourage you to read that article or watch the video.

Now, let’s go to scenario two. If he has a tracheostomy and he stops breathing well, once again, why is he stopping breathing? What are the underlying conditions? Is he too weak? Is he tired? Is there another condition that leads to him not breathing? Because if that is the case, then the underlying condition needs to be addressed, needs to be fixed. If it can’t be addressed, if it can’t be fixed, your son, unfortunately, might need mechanical ventilation and tracheostomy for the rest of his life. Again, you haven’t shared enough information.

But once again, it’s clear to me that you know 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. That’s another classical example here of that, you don’t know what you don’t know. So, if he’s got a tracheostomy and he stops breathing, once again, can they do try a different approach? Can they start mobilizing your son? Can they stimulate him? Is he still on sedatives and opiates even though he’s got a tracheostomy?

There’s no need for sedation and opiates in most cases when someone has a tracheostomy. So, a lot of ground needs to be covered here in order to find out what is exactly happening, and we can cover that ground here at the intensivecarehotline.com, that’s our consulting and advocacy, that’s giving you a second opinion, but we need more information.

Now, also, let’s just run through the worst-case scenario. Let’s just say your son is unable to come off the ventilator and the tracheostomy, you should be looking at an option, Intensive Care at Home, and consider home care instead of intensive care, especially if he can’t come off the ventilator. Otherwise, he’ll be “living in ICU” or in other facilities, for God knows how long. So, home care is the best option here in most cases, so have a look at intensivecareathome.com to give you other options. But what you really need here is you need someone who can walk you through this step-by-step and give you a second opinion and explain the situation to you in more detail than I can in this video. Also, you need to give me more information so I can help you in much detail.

Because of that, we have also created a membership for families of critically ill patients in intensive care where you can get all your questions answered in detail. 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 in intensive care related. You can get access to our membership for families of critically ill patients in intensive care when you go to intensivecarehotline.com, click on the membership link or you go to intensivecaresupport.org directly.

I also offer one-on-one consulting and advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and directly. I ask all the questions that need to be asked and you haven’t even considered asking, and that will be a game changer for you. It’ll change the dynamics in your favor.

I have worked in critical care for over 20 years in three different countries where I have also worked as a nurse unit manager for over 5 years. I have been consulting and advocating for families in intensive care here at intensivecarehotline.com since 2013. I can say without any hint of exaggeration that we have saved lives with our consulting and advocacy.

You can look at our testimonial section or you can look at our podcast and listen to what our clients are saying, and how we help them to save their loved one’s life.

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.

I also represent you in family meetings with intensive care teams so that you have clinical advocacy there, you have strong representation, and you get what you want so that your loved one gets the best care and treatment.

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].

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 or what questions and insights you have, share the video with your friends and families.

Thanks for watching.

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

Take care for now.