Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

Quick Tip for Families in Intensive Care: Should My Dad in ICU on Ventilation with Tracheostomy Be Sedated? He’s Also Pulling Out His NG (Nasogastric) Tube!

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

So today, I want to answer a question from one of our members. We have a membership for families of critically ill patients in intensive care where you can get access to me at intensivecarehotline.com, if you click on the membership link, or if you’re going to intensivecaresupport.org directly.

Without further ado, let me read out the question from one of our members, and I will answer it.

“Hi Patrik and Team, 

I did mention to my mom to get the portal set up and normally can’t get to see my dad’s records online. I need to push her to try to do it on her own.” 

This is a member who has their dad in and out of ICU with ventilation and tracheostomy and she continues in her email.

“My dad seems to be doing well though at the moment, he’s almost weaned off the ventilator and possibly very soon, but he does seem to still need suction. I have seen they’re still wanting to sedate him and I feel like this was because he moves a lot and I also got the sense the nurse on staff yesterday was busy with his other patient who was in a more critical condition. Some nurses seem on board not to sedate him though. He’s also taking something the neurologist prescribed for head movements. He does the movement of his head were concerning them with his tracheostomy.”

Now just very quickly comment here before I carry on in your email. Someone with a tracheostomy should not need sedation, with a few exceptions. One of the whole reasons you do a tracheostomy  instead of using a breathing tube  in the mouth is, to reduce and in most cases eliminate sedation and opiates completely because a tracheostomy can be so much easier tolerated than a breathing tube just as a side note here. And I agree that movements with his head could be concerning with the tracheostomy because it could cause pressure sores. It could cause the tracheostomy to dislodge and that could be life-threatening.

Carrying on from our member’s email.

“My dad pulled his feeding tubes out a few times so his hands are in restraints again. His eye contact is looking more clear now. On Monday, he gave my mom and my brother about six thumbs up throughout the day to questions. The nurse asked him to move his tongue today and he did, he seemed to mouth hi to me today, but I’m not sure because he does open and close his mouth a lot. I asked for a thumbs up which looked like he was trying to, though. 

They’ve started him on physical therapy and had him sitting on the side of the bed today and when the doctor came in, she said his blood work looked good today.

Overall, I feel like they’ve been kind and supportive to us and care about giving him a chance. We only had one doom and gloom nurse on day two here. 

Lastly, my mom doesn’t want to give him the feeding tube. She’s concerned because it does look like he has lost a lot of weight. The first day there he was throwing up a lot. But he hasn’t since my mom thinks the tubes are bothering him and she thinks the feeding tube in his stomach is a better option. I don’t know how to advise her on this one. 

Thank you so much for all your prayers and support. God bless you for all you’re doing God’s work. I attached a picture of my dad with thumbs up.” 

We’re not sharing the picture, of course. So thank you so much and I’m not mentioning names here and we’re always here to continue giving valuable advice to help you, your family and your dad. Thank you also for taking the time to provide such a detailed update on your dad’s condition.

It’s good to hear that he’s making progress in his recovery. The fact that he’s almost weaned off from the ventilator is a significant step forward. We hope that they will continue mobilizing him to strengthen his lung muscles and other muscles and he’ll help facilitate, weaning him off the ventilator soon.

And that’s why it’s so important your dad is close to coming off the ventilator. Why would you sedate someone that’s close to coming off the ventilator? Also, when someone is on a ventilator with a breathing tube or tracheostomy, they’re not getting mobilized, patients are deconditioning really, really quickly in real time. That is a reality. So really ICUs have no time to waste to mobilize a patient.

Next regarding sedation, it is important to minimize its usage to prevent any potential complications that may arise. They need to carefully assess him before administering it. You mentioned that the neurologist prescribed medication for his head movement.

We hope we can have access to the online chart, soon so we can gain a better understanding of his treatment plan. Having access to the chart would allow us to review the details and provide more comprehensive support and insights.

If he’s been pulling out tubes a few times, so he’s been on restraints again. However, it is crucial for them to regularly reassess his need for restraints, to prevent any adverse outcomes like circulation issues, skin breakdown, and psychological distress. You can also talk to your dad and explain to him the importance of the feeding tube and the potential risks of removing it. His thumbs up responses and attempts to respond to questions are positive signs of progress and indicate that he’s making efforts to communicate with his loved ones. Continued interaction and support from your family could greatly contribute to his recovery process.

It is also wonderful to hear about the initiation of physical therapy and the positive feedback from the doctor regarding his blood work. Physical therapy plays a vital role in helping him regain strength and mobility. It’s good to know that they are providing him with the necessary care and rehabilitation support. Your dad losing weight is really a concern. Adequate nutrition is critical for his recovery. It may be beneficial to consult a nutritionist or dietitian or gastroenterologist who can assess his exact his exact needs and develop the most suitable approach to meet his nutritional requirements.

Furthermore, considering your mom’s concerns about the nasogastric feeding tubes, bothering your dad, the idea of a feeding tube inserted directly into the stomach, known as a Percutaneous Endoscopic Gastrostomy, also known as PEG  can be considered if he continues pulling out the tubes repeatedly.

However, it is also important to involve the speech-language pathologist in the assessment process who will evaluate your dad’s swallowing abilities and determine if he has the potential to tolerate oral feeding without the need for a PEG. They will assess his ability to control secretions and coordinate swallowing and breathing. They will assess his ability to safely swallow and manage different foods and liquids consistencies.

We really hope that everything is going well. It’s great to see your dad’s picture with thumbs up. It’s truly heartwarming to see his positive spirits despite all the challenges.

Now, if you have a loved one in intensive care and you also want your questions answered, you can become a member in our membership for families of critically ill patients in intensive care at intensivecarehotline.com by clicking on the membership link. Or you go to intensivecaresupport.org directly. And in the membership, you have access to me and my team 24 hours a day and we answer all questions intensive care related.

Now, I also offer one on one consulting and advocacy for families in intensive care over the phone, via Skype, Zoom, WhatsApp, whichever medium works best for you. I also talk to doctors and nurses directly. I talk to you and your families directly and give you a world-class education about intensive care and the opportunities and as well as the pitfalls. I put perspective around your loved one being in intensive care and I’m not giving you the doom and gloom that the intensive care team is giving to you. I’m giving you real-world experience that’s objective and not biased by hospital agendas. By me doing so, you are in a position to make informed decisions, have peace of mind, control, power and influence fast.

I also represent you in family meetings with the intensive care team so that you have clinical representation in the meeting as well as an advocate. So that once again you make informed decisions, and have peace of mind, control, power, and influence. And most of all I ask all the questions that you haven’t even considered asking.

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, we offer medical record reviews in real time so that you can have a second opinion in real time. On top of me talking to doctors and nurses directly. So reach out if you want a medical record review in real time for your loved one in intensive care. 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 and you want regular updates for families in intensive care, subscribe to my YouTube channel. Click the like button, click the notification bell. Comment below what you want to see next and 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.