My name is Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

We’ve been consulting and advocating families in intensive care all over the world since 2013. Here at intensivecarehotline.com, we instantly improve the lives for families of critically ill patients in intensive care so that you can make informed decisions, have peace of mind, control, power and influence, making sure your loved one always gets best care and treatment even if you’re not a doctor or a nurse in intensive care.

Today I’m answering a question from Jose, who left a comment on my YouTube channel who says:

Hi Patrik,

My little brother was off sedatives for half a day and extubated for 7 hours and was still showing signs of agitated delirium and the doctors chose to intubate him and run CT and MRI scans.

Why? If 24 to 48 hours is normal to be in that state.

– Jose.

Well thank you for your comment, Jose, and I’m really sorry to hear that your little brother is going through this. I can absolutely understand why this feels confusing and frustrating, and I want to try and give you some clarity. So let me address your question directly because it’s a really important one.

Yes, 24 to 48 hours of agitated delirium after extubation is normal. There’s more to this story.

You’re absolutely right that agitation, confusion, and delirium after being taken off sedation and being extubated in ICU is very common and very normal. When a patient has been on sedatives, opiates, and other ICU medications, particularly for a prolonged period of time, the brain and body take time to clear those drugs and reorientate.

Agitated delirium in the 1st 24 to 48 hours after extubation is well documented and expected. So, on the face of it, your brother showing signs of agitated delirium 7 hours after extubation is not by itself a reason to immediately reintubate and rush to CT and MRI scans. You are correct to question that.

But here is what you and your family need to understand and also question. The decision to reintubate and order imaging was made by the ICU team for a reason. The question is whether that reason was clearly explained to your family and whether it was the right decision for your brother.

There are situations where reintubation and neurological imaging after agitated delirium is clinically justified. These include if the agitation was so severe that your brother was putting himself at risk, pulling all lines, tubes, or moving dangerously and could not be safely managed with lighter sedation or physical de-escalation. If the ICU team identified new neurological signs during the delirium, such as focal weakness, one-sided changes, abnormal pupils, or new seizure-like activity that made them concerned about an underlying cause beyond drug-related delirium.  If there was a deterioration in respiratory function alongside the agitation, meaning your brother was not only delirious but also struggling to breathe adequately after extubation. If your brother’s underlying diagnosis or reason for being in the ICU in the first place creates a higher clinical suspicion of a neurological complication, for example, after cardiac arrest, major trauma, or brain related admission.

However, if the only reason for reintubation was agitated delirium in isolation without any of the above, then your family has every right to ask the ICU team exactly what their clinical reasoning was, and that is a conversation worth having.

This is exactly why you need access to all your brother’s medical records. This is something I say to every family in intensive care, and I can’t stress it enough. You need to get access to your brother’s full medical records, not a summary, not a verbal update on the corridor, the actual documented clinical notes and evidence: the nursing observations, the doctor’s notes, the nursing notes, the sedation charts, the ventilator parameters before and after extubation, all medications he’s on, all pathology and lab results, all fluid balance charts and the results of the CT and MRI scans that were performed.

Why? Because the medical records will tell you exactly what the ICU team saw, what they were concerned about, and what the imaging showed. If the CT or MRI scan came back normal, that is actually reassuring, it means the team ruled out a serious neurological complication. If there were new findings of the imaging. You need to know what they are and what they mean by your brother’s treatment and prognosis. Without access to these records, you are making decisions and forming opinions based on incomplete information, and in an ICU situation, that is a position no family should be in.

And just as a side note, you have the right to access medical records. In most countries, family members who are the next of kin or legal next of kin or have power of attorney or are the medical proxy have the right to request a copy of a patient’s medical records. Ask the ICU team for a full clinical summary and request the imaging results in writing. Do not accept vague verbal explanations for major decisions like reintubation. Ask – can you give me access to their medical records so that I can see what you documented, why this decision was made. And do not budge on getting access to the medical records. If you can’t get access to the medical records, your first question needs to go to what is it that you can’t see and what is it they’re trying to hide?

This is where I want to tell you about something we do at intensivecarehotline.com and something that I believe will genuinely help your brother’s situation right now. I offer consulting and advocacy calls where I or one of my team of specialist ICU nurses will get on a call with you and if needed with your brother’s ICU team, and we will help you ask the right questions, understand the answers, and advocate for the best possible care for your brother.

Specifically, in your brother’s situation, a consulting call will help you understand why the decision was made to reintubate after only 7 hours and whether that was the right call clinically. What the CT and MRI results showed, and what they mean for your brother’s pathway, what the plan is now for weaning, re-extubation, and managing delirium differently the next time, what your family can do to actively support your brother’s recovery including reorientation strategies, having familiar voices in the room and advocating for a lighter sedation approach, whether tracheostomy should be considered if weaning continues to be difficult, and what that means for your brother’s future.

Having an expert ICU nurse advocate in your corner, someone who speaks in the language of the ICU team, who knows what questions to ask, and who can cut through the medical jargon, can be transformative for families in exactly your situation. So, book a consulting call now at intensivecarehotline.com or call me directly on one of the numbers on the top of the website at intensivecarehotline.com.

Jose, I also want to plant the seed for you because sometimes in ICU situations like your brother is in, families only find out about their options when it’s almost too late to plan properly.

If your brother’s weaning from the ventilator continues to be difficult, if the ICU team starts talking about a tracheostomy or long-term ventilation, or if they begin hinting that he may not be able to leave the ICU, please know that there’s an option that most ICU teams do not proactively tell families about intensive care at home at intensivecareathome.com. We provide 24-hour specialist intensive care in nursing in your brother’s own home.

We support patients who are on invasive mechanical ventilation via a tracheostomy, patients on non-invasive ventilation such as BiPAP (bilevel positive airway pressure) or CPAP (continuous positive airway pressure), and patients who are tracheostomy dependent but no longer ventilated, we also support patients and families who are navigating palliative care, where the goal is quality of life and dignity at home, rather than ongoing aggressive treatment in a hospital bed.

In other words, even if your brother cannot be weaned off the ventilator, needs a tracheostomy, staying in the ICU indefinitely is not the only option. He can come home with professional ICU level nursing beside him 24/7 and have real quality of life with his family around him. Go and check out intensivecareathome.com where you get 24-hour intensive care trained nursing in your home for invasive ventilation, tracheostomy care, non-invasive ventilation, it’s a genuine alternative to a long-term ICU stay for patients who cannot be weaned or who need ongoing complex care. It can also go towards palliative care if that’s what the patient or the family wishes.

What I want you to do right now, Jose, get access to your brother’s full medical records, including CT and MRI results, ask the ICU team directly what specific clinical findings led to the decision to reintubate and can you document for us.

Book a consulting call with myself or call us on one of the numbers on the top of our website, and if long-term ventilation or tracheostomy is mentioned, go to intensivecareathome.com to understand all your options before discharge, and of course subscribe to my YouTube channel and subscribe to our email newsletter at intensivecarehotline.com.

I really hope your brother recovers well, Jose. Agitated delirium after extubation is something we see regularly, and in most cases, it does resolve, but your questions are the right questions. And you deserve the right and clear answers.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.

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 why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, 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 simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking 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 in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and 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. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

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.

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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.