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

So, when people come to our website at intensivecarehotline.com and they opt in for their free instant impact report, we ask them what is their biggest frustration when they enter their email address so they can get their free instant impact report and sign up for our free email newsletter. And obviously, we have a lot of insights on what people say to us. And most of my videos here are what people tell us, what frustrations they have, or they are real-life case studies when we work with clients one-to-one. That’s really how I make these videos here. It’s all real-world stuff.

So, one of our recent frustrations that someone wrote in when they opted in for their free instant impact report was, “Tracheostomy and PEG tube as a frustration.” And that can be a massive frustration, especially when the intensive care team is not doing everything beyond the shadow of a doubt to get your loved one off the ventilator and the breathing tube in the first place to avoid a tracheostomy and the PEG (Percutaneous Endoscopic Gastrostomy) tube.

What we are seeing over and over again is that many ICUs do a tracheostomy prematurely, and they haven’t taken sedation off early enough. They haven’t done spontaneous breathing trials early enough. They are not mobilizing patients. They are not doing physical therapy or physiotherapy with their patients. And therefore, it takes a lot longer for those patients to either wake up or to move towards spontaneous breathing trials and have them extubated or the breathing tube removed.

Now, disclaimer here, of course, it really depends on what condition someone is in intensive care for and what condition someone is ventilated with. For example, if someone, God forbid, has a traumatic accident like a motor vehicle accident and they have massive upper body fractures including rib fractures and it would be very painful for them to breathe. Of course, there’s exceptions to the rule.

But if someone is in ICU with a medical condition without any fractures or without any major surgery, maybe they’re in ICU with a sepsis or with a pneumonia, or even with a heart attack they should be moving towards having sedation reduced and opiates reduced, and physical therapy started as quickly as possible. As soon as their hemodynamically stable, of course, and sit them up in bed, sit them out of bed even in a recliner chair or in a tilt table, and move them towards extubation as quickly as possible so that a tracheostomy and a PEG tube can be avoided in the first place.

Every day that someone spends on a ventilator, deconditioning is real. So, you got to get patients up and mobilizing, and off sedation, off opiates as quickly as possible. Every day counts.

Again, what we are seeing by talking to ICUs all around the world is that many ICUs now are getting complacent. It’s easier for them to use more and more sedatives, more and more opiates, and not focused on trying to avoid the tracheostomy and the PEG and working towards extubation as quickly as possible. It is more work, much more work for ICUs than keeping patients sedated and on opiates, doing a tracheostomy, doing a PEG tube, and then send them to LTAC (Long Term Acute Care), especially for our client base in the U.S. It’s different in the U.K. or in Australia. A PEG is often a very last resort, but even a tracheostomy can be done there early as well.

But in the U.S. in particular, when we work with clients one-on-one and when we talk to ICUs directly, there just seems to be no longer any sense of urgency to remove sedation, to remove opiates, to move towards mobilization,  physical therapy as quickly as possible, and work towards extubation as quickly as possible.

Now, I have also written an article and made a video about how to extubate someone in intensive care, a step-by-step process. “How to avoid a tracheostomy” and move someone from intubation to extubation as quickly as possible are linked below this video. So, you can check out that video, so you actually know what needs to be done step-by-step to get your loved one off the ventilator and the breathing tube and avoid tracheostomy and the PEG tube.

So, that is my quick tip for today.

If you have a loved one in intensive care, go to intensivcarehotline.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.

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 a membership area and via email, and we answer all questions intensive care related.

Now, if you need a medical record review for your loved one in intensive care, we can help you with that as well. We review medical records in real time for patients in intensive care. We also review them after intensive care especially if you have unanswered questions, you need closure, or if you are concerned that there has been any medical negligence. We can identify any of it. But we highly recommend that we help you review medical records in real time so you can have that crucial second opinion in real time and have someone explain to you what it all means.

Also, I do one-to-one consulting and advocacy directly. You can talk to me on the phone, and I also talk to doctors and nurses directly in the ICU if that’s what you would like me to do.

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.

Take care.

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