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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
Today’s tip is about a client asking, “The ICU team has told me my dad will never come off the ventilator. Is this true?” Well, great question, and let’s look at the facts here. And may I start with, that 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. And this could not be a better example for what I just said.
So, client comes to us and says, “Hey, my 78-year-old dad has Parkinson’s. He’s got dementia. He aspirated at home on food, and he ended up with an aspiration pneumonia in ICU. And now, the doctors are telling me he will never come off the ventilator and he needs a tracheostomy, and he needs to go to a nursing home or to LTAC, and he will never get off the ventilator. Well, let’s look at the facts.
So, we asked the client to give us facts and give us picture of the ventilator, give us an arterial blood gas, give us a chest x-ray and let’s look at the facts on what they’re claiming is true. And this is about day 4 or day 5 in ICU. And the ICU also pushing the family to say, “Well, he either needs a tracheostomy or he will need to go to hospice.” Painting a really black and white picture without looking at the real facts. And it’s confirming again that ICUs have agendas that are not necessarily in the best interest of a patient when we look at the facts.
So, the facts were this, the patient was on pressure support ventilation with a PEEP (positive end expiratory pressure) of 5, with a pressure support of 10, and with 30% FiO2 (Fraction of Inspired Oxygen) or oxygen delivery. His tidal volumes were adequate for his weight and his minute volumes were adequate as well. And the arterial blood gases were pretty good as well, i.e., he just wasn’t awake enough to get off the ventilator. And once he’s coming out of the induced coma, it shouldn’t be a problem to take this patient off a ventilator. Yes, he’s got Parkinson’s and he’s confused, and he’s got dementia, but that doesn’t necessarily mean he can’t be extubated. It has to be given a go once he’s more awake.
And again, it goes to show that the biggest challenge for families in intensive care is simply that they don’t know what they don’t know, and that they don’t know what questions to ask and what to look for. And they don’t know their rights either, and they don’t know how to manage doctors and nurses in intensive care because once you start asking the right questions, the dynamics will change in your favor.
I can tell you which patients can’t come off the ventilator. Generally speaking, the patients that can’t come off the ventilator are patients that have, God forbid, a C1 and C2 spinal injury or have motor neuron disease or have any other neuromuscular disease such as cerebral palsy. With Intensive Care at Home, for example, we have cerebral palsy clients at home that have a tracheostomy and are fully ventilator-dependent.
So, that is my quick tip for today. I really hope that helps you.
If you have a loved one in a similar situation, you got to get professional help. You got to get someone asking the right questions and piecing the puzzle together for you, so you are educated about treatment options.
Now, 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 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 answering questions about intensive care and Intensive Care at Home, 24 hours a day, in a membership area and via email.
If you need a medical record review, please contact us as well and we can help you with a medical record review while your loved one is in ICU or after ICU if you suspect medical negligence or if you have any questions that remain unanswered.
And, subscribe to my YouTube channel for regular updates for families in intensive care, share the video with your friends and families, click the like button, click the notification bell, 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’ll talk to you in a few days.