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Quick Tip for Families in Intensive Care: Should My Dad in ICU Be in an Induced Coma and Have a Breathing Tube with a Respiratory Virus?

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

So today’s tip is about a question that I had from Brodie who says, “I would like to know whether my dad who’s in ICU with the respiratory virus should be induced into a coma. My concerns are that he would lose his respiratory drive, who has limited lung function, which is obvious at the moment. So wouldn’t induced coma be of benefit for him?”

Well, that’s a great question Brodie, and let’s break this down.

So many people have respiratory viruses and they don’t end up in ICU. Let’s just take  COVID. COVID is a respiratory virus and most people didn’t go into ICU. So the question here really is, can the respiratory virus be treated without an induced coma? Basically, what you’re not saying is, well, if he did go into an induced coma what else needs to happen?

Well, if he does go into an induced coma, he would also need mechanical ventilation with a breathing tube . And the question here is, can that be avoided? I don’t have the answer yet, but I’ll give you different scenarios that I’ve seen over the years.

And by the way, I have worked in intensive care for over 20 years as a critical care nurse in three different countries. I also worked as a nurse manager for over five years in intensive care. And I’ve been consulting and advocating for families in intensive care for over 10 years here as part of intensivecarehotline.com. 

So, when someone goes into ICU with a respiratory virus, they might end up on some oxygen. They might end up on some high-flow nasal oxygen, depending on the severity of the of the symptoms. Are oxygen levels dropping? What’s his oxygen saturation like? If his oxygen saturation stays above 92, or 94% he may be ok with whatever they’re doing.

Assuming his respiratory drive is normal, assuming his breathing rate is normal and it’s not too fast, and also not too shallow, so your dad needs to be able to take deep breaths, and also needs to be able to cough. As long as he can do all of that, and oxygen stays above 92, 94% oxygen saturation. He should be fine.

Now, if that is no longer sufficient that he’s getting oxygen or high-flow nasal oxygen, then the next step is to have BIPAP (Bilevel Positive Airway Pressure) or CPAP (Continuous Positive Airway Pressure) ventilation with a mask. And that is much better than going into an induced coma with the breathing tube and a ventilator attached, right. So the next step is to try BiPAP or CPAP and see if that works.

Now, that is way more uncomfortable than nasal oxygen or high flow nasal prongs. So it’s sort of the next level towards mechanical ventilation and an induced coma. So, with a breathing mask, or a BiPAP mask, your dad gets pressure and oxygen. He gets PEEP, a Positive End Expiratory Pressure or potentially with a BiPAP, he gets two levels of PEEP IPAP and EPAP. And that might improve his situation.

Also, it expands the lungs. The BiPAP, with the CPAP, expands the lungs unlike oxygen or high flow nasal prongs. High-flow nasal prongs has a low PEEP and not as efficient as BiPAP or CPAP. So if CPAP or BiPAP is effective, no need for your dad to go into an induced coma and have a breathing tube and a ventilator attached.

Now, what else can be done in a situation like that? Of course, he would need anti-viral treatment. Other things that they would measure if your dad keeps deteriorating and God forbid moving towards an induced coma in the breathing tube and the ventilator. Other things that they need to monitor are arterial blood gas and of course, chest X-ray results. What do chest x-rays look like? Is there consolidation? Is there inflammation? Is there atelectasis? Someone or one of the doctors needs to have a very good look at the chest X ray and needs to look at arterial blood gases if applicable.

If your dad is now on CPAP, or BiPAP and he keeps deteriorating, arterial blood gases need to be done to determine whether the next step might be an induced coma and mechanical ventilation with the breathing tube.

So, you’re also saying he has lost his respiratory drive and he has limited lung function prior. And that might make it more likely that he needs intubation and the breathing tube and then induced coma. But all the other things need to be determined as well. Obviously, doctors and nurses need to have a good listen to your dad’s chest with the stethoscope to see whether there is air entry. Those are all things that need to be done.

Also, if your dad is up to it, physical therapy and physiotherapy might help. Breathing exercises, coughing exercises, and mobilization, so that the lungs can expand. If your dad keeps lying in bed all day, his lungs can’t expand. Some mobilization would be important. That’s assuming he’s hemodynamically stable. He doesn’t have a low blood pressure. And he’s strong enough.

Also, would be good if you could keep eating and drinking. So, nutrition is quite important as well, and also a good day and night rhythm. So being awake at night, being asleep at night, so that the body stays in a normal cycle. So I hope that answers your question, Brodie here. And if you have any other questions, you know where we are.

And if you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected]. 

Also, we have a membership for families of critically ill patients in intensive care at intensivecarehotline.com. If you click on the membership link there, or if you go to 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.

Also, I offer one one-on-one consulting and advocacy over the phone, via Skype, via Zoom, via WhatsApp, whichever medium works best for you. And I talk to doctors and nurses directly. I talk to you and your families directly and I make sure you make informed decisions, have peace of mind, control, power, and influence, which is obviously critical when you have a loved one in intensive care. You can’t afford to fly blind. You always need to have a second opinion. You always need to have someone that can guide you during those very challenging and often life or death situations.

I also represent you in family meetings with intensive care teams so that you have clinical representation and you have an advocate by your side. Once again, I ask all the questions you haven’t even considered asking, but you must ask when you have a loved one in intensive care so that you make informed decisions, and have peace of mind control, power, and influence.

We also offer medical record reviews in real-time for a second opinion. So if you want a second opinion, we offer medical record reviews in real time.

And, of course, by me talking to doctors and nurses directly by asking the questions you haven’t even considered asking because I have specialized knowledge will also help you to make informed decisions, and have peace of mind control, power and influence.

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.

Now, 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 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.