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

So, today’s tip is for Loretta who has an email and Loretta says,

“Hi Patrik, 

My brother nodded yes when asked if he wanted some ice cream today. Again, he is in a medically induced coma for being septic and they have been lowering the medications to try and bring him out of his coma slowly and are having a tracheostomy to be scheduled. 

Do you think that this is necessary to do a tracheostomy? 

Can you give me your professional opinion on what you think about the situation right now that I just told you about?”

Well, the good news is Loretta that your brother is waking up and that he wants ice cream. That’s a good thing, that means his brain must be working. So, that’s the positives.

If he’s neurologically intact, which it sounds to me like he is, if he’s nodding, if he can answer questions appropriately, then the question whether he should have a tracheostomy, lies in his ventilator settings.

So, “He’s in a medically induced coma. They are lowering medications. Does that mean he’s strong enough to breathe up and have the breathing tube removed and breathe on his own?” That’s where the question really lies with and the answer.

What are his ventilator settings? Is he breathing in CPAP (continuous positive airway pressure), pressure support ventilation mode? Is his breathing rate normal between sort of 8 to 20, 24? Are his tidal volumes adequate for his weight, which means 7 to 10 ml per kilo. So, let’s just say your brother is 80 kg, 7 to 10 ml per breath. That means around, 650 to 800 ml per breath.

So, if that is maintained, what is his PEEP (positive end expiratory pressure) like? Is his PEEP less than 5 or 5? Is his pressure support less than 10? Are his arterial blood gases within normal range? Is he having a good strong cough? Can he clear his airway? That is when he can actually be taken off the ventilator and won’t need the tracheostomy.

If he’s not ready to be extubated because the support he needs from the ventilator is too high, then he will need a tracheostomy.

On the other hand, it also depends how many days he’s been in the induced coma for. Maybe it’s only been a couple of days, maybe it’s only been 3 or 4 days. Then he’s certainly shouldn’t have a tracheostomy. It should only be done Day 10, Day 14. So, you need to look at timelines as well.

If he’s awake, if he can obey commands, if he can have a meaningful response to questions, if he’s breathing and pressure support CPAP on low settings, he can clear his airway, his arterial blood tests gases are fine, then he should be extubated and then a tracheostomy is not needed. If he can’t meet those criteria then a tracheostomy be needed after Day 10 to Day 14 of mechanical ventilation and the breathing tube. So, I hope that helps.

I have written an article about, “How to wean a critically ill patient off the breathing tube and the ventilator?” and I will link towards an article below. You can have a look at it in more detail.

I have worked in critical care nursing for nearly 25 years in three different countries where I’ve worked as a nurse manager for over 5 years and where I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. 

We have helped hundreds of clients at intensivecarehotline.com and members. We have a membership for families of critically ill patients in intensive care and we have saved many lives. You can confirm that on our testimonial section at intensivecarehotline.com, click on the testimonial section or go on our intensivecarehotline.com podcast where we have interviewed some of our clients, verifying that we have saved some of their loved one’s lives.

That’s why we’ve created the 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, 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 e-books and 21 videos that I personally written and recorded and that will help you to make informed decisions, have peace of mind, control, power, influence so that you can influence decision making part 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, and I talk to you and your families directly. I talk to doctors and nurses directly. I will handhold you through this once in a lifetime situation that you simply can’t afford to get wrong. I also represent you in family meetings with intensive care teams. 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.

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, or 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, share this video with your friends and families, comment below what you want to see next, what questions and insights you have.

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 my intensivecarehotline.com email newsletter.

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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