Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

If you want to know what you need to do if your loved one is critically ill in intensive care and is on high oxygen levels on the Hudson mask or face mask, and the ICU team is refusing intubation, stay tuned. I’ve got news for you.

So, I had an email from Dominique who says,

“Hi Patrik,

The ICU team is refusing intubation for my mom who’s 69 years of age while she’s on high levels of oxygen and on the Hudson mask or on the face mask. They’re saying there won’t be any improvement if she’s being intubated, then she won’t survive.”

My name is Patrik Hutzel from intensivecarehotline.com and I have another quick tip for families in intensive care today.

So, what should you be doing in a situation like that? Obviously, the first thing is to clarify if your mom would want intubation, and if she can make her own decision. Maybe she can talk, you should definitely talk to her and say, “Hey, is that what you want? Are you clear that you want intubation and go through with an induced coma and the side effects of all of that?” Maybe your mom has an advanced care plan, if there’s an advanced care plan, it’s clearly documented. If your mom can’t make a decision because she’s unconscious, then you need to make a decision on her behalf, of course.

You should also ask the ICU doctors why they are not intubating, of course, and request a clear explanation of your mother’s condition, prognosis, and why intubation is not recommended. But the bottom line is this, if your mom is not being intubated, it sounds like she’s going to die. If she is being intubated, she may die, but she also will have a chance to recover and survive.

Next, you need to request a second opinion. You can ask for another ICU consultant or respiratory specialist to review her case. If available, consult the hospital’s ethics or patient advocacy team. From my experience, consulting the hospital’s ethics or patient advocacy team is almost a waste of your time, and I’ll tell you why. They’re hospital employees, they’re not impartial, and they’re not objective because they are hospital employees, and they would always defend the hospital’s agenda. So, it’s almost a waste of your time. But we can give you a second opinion here at intensivecareholine.com.

Also, let’s look at alternative treatments. For example, if your mom is on oxygen therapy with a Hudson mask or a face mask, and she’s not maintaining her airways, she can’t breathe, her blood gases are poor, chest X-rays are poor, then other opportunities and options are non-invasive ventilation, such as BIPAP (Bilevel Positive Airway Pressure) or CPAP (Continuous Positive Airway Pressure) or high-flow nasal oxygen, such as the Airvo would help, and see if blood gases improve, see if chest X-ray improve. You also need to check if there are any irreversible factors that could improve her oxygen levels.

Also, you need to look at does she potentially need a bronchoscopy? Does she potentially need some deep suctioning? Does she need some physical therapy, breathing exercises, and so forth? What else can improve her poor respiratory status, including what can improve her blood gases?

Next, understand her goals of care. If the ICU team believes intubation won’t improve her outcome, ask about comfort focused care and palliative support. But that’s only if you are agreeing with the intensive care team’s approach, which I don’t think you do, which means, you need to get in some advocacy. You need to get in someone like we do here in Intensive Care Hotline where someone can advocate for your critically ill loved one who understands intensive care inside out just as they do but also understands about patients’ rights.

I argue that if the intensive care team lets your mom go without intubating her, that could be perceived as murder, and you need to think about those things. Just because the intensive care team says, “Oh, it’s okay to kill your mom”, doesn’t mean it’s legal. Probably isn’t. Once again, you need to discuss what treatment options align with your mom’s wishes, and it sounds to me like your mom’s wish is to live and with her quality of life.

So, there’s actually a number of things that can be done here. Like I said, most importantly, BIPAP, CPAP, high flow nasal prongs, respiratory exercises, deep breathing exercises if she’s conscious, coughing exercises, again, if she’s conscious. If not, the BIPAP and the CPAP can do some of that. The Airvo and the high flow nasal prongs can help with that.

But it’s more importantly, if your mom doesn’t want to die and you don’t want your mom to die, and she has expressed no wishes to die, then the intensive care team really needs to intubate her, and you shouldn’t be negotiating on that because, like I said, if they’re not doing that, then I argue that could be perceived as euthanasia or even as murder. That’s the way to look at these things.

Most likely, intensive care team needs a bed, needs an ICU bed. They probably have surgery coming in the next day, in the next few days, and they need ICU beds, and one way for them to manage their ICU beds is giving you a negative prognosis, giving you the doom and gloom.

Also, I have been making many videos about real versus perceived end of life situations. A real end of life situation is a situation where a patient is definitely going to die, no matter treatment, medication, surgery. No, nothing will save your loved one’s life. A perceived end of life situation is that there’s a perception and that things can be done. In your mom’s case, things can be done. She can be intubated and give her a chance. If she’s not going to make it, she won’t make it on intubation either, but at least she’s had a chance, if they’re doing all the right things. So, once again, by withholding treatment, they can manage their ICU beds better, and I argue it could be perceived as murder, and that’s not a good thing. That is not a good thing. That’s why you need a second opinion, that’s why you need advocacy.

I have worked in critical care nursing for 25 years in 3 different countries, where I worked as a nurse manager for over 5 years in intensive care, and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients in intensive care and critical care. You can verify that on our testimonial section or on our intensivecarehotline.com podcast section where we’ve done client interviews.

You can join growing number of clients and members that we helped over the years to save their lives, improve their loved ones’ outcomes, and because we advocate for better treatment, we understand patients’ rights in intensive care inside out. Something the intensive care team wants you to think that you don’t have any rights, well, you do. We just need to exercise them, and you need to exercise them intelligently. Our advice is life changing. It’s absolutely life changing. Once again, you can verify that on our testimonial section at intensivecareholine.com, and you can verify it on our intensivecareholine.com podcast section where we’ve done client interviews.

That’s one of the reasons why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. I also talk to doctors and nurses directly with you or on your behalf. I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time, so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

All of that, you get at intensivecarehotline.com where we also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the link and you can join the membership there or you go to intensivecaresupport.org directly. In the membership, you also have exclusive 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. There, you also have exclusive access to 21 e-books and 21 videos that I have personally written and recorded, and that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment, always.

All of that, you get at intensivecarehotline.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.

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

I also do a weekly YouTube Live where I answer your questions live on a show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel, or if you are a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com.

Thank you so much for watching.

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

Take care for now.

Related Articles:

Quick Tip for Families in Intensive Care: My 80-year-old Mother is in ICU on BIPAP. Why is She Not Allowed to Eat or Drink? Quick Tip for Families in Intensive Care: My Mother is in ICU Intubated and Heavily Sedated for Over 2 Weeks and Now She Won’t Wake Up! Quick Tip for Families in Intensive Care: What Went Wrong and Why Did My Husband Have to be Put on a Ventilator and in an Induced Coma? Quick Tip for Families in Intensive Care: What are Options for My Ventilated 7-Month-Old Son in NICU with Lung Disease? He was Born at 24 Weeks. Quick Tip for Families in Intensive Care: Is it a Good Sign that My Dad is Coming off Vasopressors Whilst on Dialysis in Intensive Care?