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

So today, I was talking to a client who has a 31-year-old son in intensive care after a difficult intubation after a respiratory arrest, where they had to use a bougie which probably delayed him getting oxygen to the brain because the lady was saying that they have diagnosed him with an anoxic brain injury. But on top of that, because of the respiratory arrest, he also went into cardiac arrest twice within 48 hours after intubation.

Now, the intensive care team, after seven days in ICU, is wanting to focus on end-of-life care for a 31-year-old man previously fit and healthy. So now, this lady is faced with a dilemma of having the push from ICU to move towards end of life or having to do a tracheostomy and send her son to LTAC (long-term acute care). This is a client in the U.S.

So, when she asked me what’s my advice here? Well, my advice here is this that do you want to move towards end of life for your 31-year-old son after seven days in intensive care? Seven days in intensive care is not a long time. Seven weeks in intensive care may be perceived as a long time, but certainly not seven days. If she was to move towards palliative care or end-of-life care, that would be the end of it and there’s no way to return from that as far as we know.

So, why would you not give your son a chance? Which is I know she will do now, and she will move towards a tracheostomy but even moving towards a tracheostomy just because the intensive care team is saying he’s got anoxic brain injury and he will be in a vegetative state for the rest of his life, she hasn’t even spoken to the neurologist because this is all information that’s coming from the intensive care team, so, I asked her to speak to a neurologist as quickly as possible to get it from the expert. The neurologist is the expert on the brain. The intensive care team is not the expert on the brain. It’s a different discipline.

So, after seven days in intensive care, what if he wakes up? What if he can even have the breathing tube removed? Now, it doesn’t look like it at the moment, but you have to run these scenarios through your head because what does the intensive care team want? They want him out as quickly as possible, whether they achieve that through end of life or by sending him to LTAC. It doesn’t really matter to them as long as they can achieve their goal, which is free of the ICU bed, which is the most sought-after bed in any hospital. So, you therefore need to always read between the lines.

If you’re in a similar situation, what’s the best course of action? Well, I tell you the best course of action from my perspective, once again, try and wake him up, move him towards extubation, if that’s possible. If that’s not possible because he does have an anoxic brain injury and he’s not waking up, then move towards a tracheostomy and see how he improves over time with rehabilitation.

But also, because you are in the U.S., I would not give consent to a PEG (Percutaneous Endoscopic Gastrostomy) tube because once your son has a tracheostomy and a PEG, they can move him to LTAC, assuming you are giving consent to that. If he doesn’t have a PEG tube, they won’t take him in LTAC. They won’t take a patient with a nasogastric feeding tube because they can’t. They’re not equipped to do that. They don’t have the skills most of the time.

So, that should also raise your red flags. If they don’t have the skills to look after a nasogastric tube, how will they possibly have the skill to look after someone on a ventilator with a tracheotomy? Which is what I’ve been saying for many years, do never go to LTAC with your loved one because LTAC are disaster areas. They do not have the skills that an intensive care unit has. They do not have the skills to look after ventilation and tracheostomy. They are the better version of a nursing home if that.

So, the best course of action here once again, move towards extubation as quickly as possible, if that’s possible, or do a tracheostomy but not a PEG tube. Your son can be perfectly well fed through a nasogastric tube. There’s no issues for that. The PEG tube is often just the vehicle to go to an LTAC. So be very mindful there, what you are giving consent to.

Now, if you have a loved one in intensive care and you don’t want to be misled by intensive care teams, please contact us at intensivecarehotline.com and 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, in the membership area and via email and we answer all questions, intensive care related.

I also offer one-to-one consulting and advocacy for families in intensive care via phone, via Zoom, via Skype, via WhatsApp, whichever medium works for you. I also talk to doctors and nurses directly. I can represent you in family meetings with the intensive care team.  Have a look at our testimonials , how many families we have helped in intensive care, turning situations around that you don’t even knew were possible.

I will ask questions to the intensive care team that you haven’t even considered asking because 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.

Also, if you need a medical record review in real time and you want a second opinion in real time, please contact us as well. We can do that for you very, very quickly if you need a medical record review after intensive care because you will need closure, you have unanswered questions, or you are simply suspecting medical negligence, please contact us. We can get that on the way for you as well.

Now, subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

Thanks for watching.

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

Take care for now.