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

So today’s question is coming from Helene, and Helene is writing in,

Hi Patrik,

My 77 year-old mom is on hydromorphine or Dilaudid in intensive care while she’s on a ventilator with a breathing tube. And I’m wondering when I researched more about Dilaudid or hydromorphine, it causes respiratory depression and respiratory distress. And why would she be on Dilaudid or hydromorphine if she’s already on a ventilator and the goal should be to wean her off the ventilator and she’s got low oxygen saturations and she has a lot of secretions? That doesn’t make any sense to me. Can you please explain?

From Helene

Hi Helene,

What a great question Helene and I’m glad you’ve asked it. So let’s look at this.

When someone is in an induced coma on a ventilator in intensive care with a breathing tube or endotracheal tube, a breathing tube or an endotracheal tube in the mouth is very, very uncomfortable plus the pressure that’s going into the lungs through the ventilation makes the whole experience very uncomfortable. And which is why patients need to be induced into a medically induced coma and medications such as hydromorphine or Dilaudid, but also morphine fentanyl, propofol, midazolam, Precedex sometimes ketamine are being used. And most of those medications quite frankly, have respiratory depression as a side effect and it’s almost counter-intuitive. You’re asking the right question here, Helene. Why would that be given?

Again, it’s for pain management and again, even though it can be, or it is counter-productive, it’s still needed to manage the treatment of mechanical ventilation. The challenge is when patients get out of the induced coma, you switch off the Dilaudid or the Hydromorph or the morphine or the fentanyl, you switch it off and the side effects still lingering around in the body, depending on kidney function, depending on liver function and so forth.

So it is a catch-22 and therefore once people are woken up and they need to be weaned off the ventilator, they need good physiotherapy, good physical therapy. They need arm exercises, breathing exercises, leg exercises. So it’s all needed to get off the ventilator. But these are the reasons why someone is on opiates, such as Hydromorph, Dilaudid, morphine and fentanyl. That is the reason why.

So that’s my quick tip for today.

If you have a loved one in intensive care, please go to intensivecarehotline.com. Call us on one of the numbers on the top of our website, or simply send me an email to [email protected] with your questions.

Like this video, give it a thumbs up, click the notification bell, subscribe to my YouTube channel for updates for families in intensive care, and leave your comments below what you want to see next, or what questions you have from this video today.

Take care for now.