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

So yesterday, I was making a video, a quick tip, where I was talking about, “What is a trial extubation in intensive care?” Today, I want to talk about, “When a trial extubation fails, how can you avoid a trial extubation failing?”

So, here’s the situation. We are currently working with a client who is also a member as part of our membership for families of critically ill patients in intensive care that you can get access to at intensivecarehotline.com when you click on the membership link or if you go to intensivecaresupport.org directly.

So, our member has her 60-year-old husband in ICU, has had him in ICU for about a couple of weeks with an aspiration pneumonia and he’s struggling to come off the ventilator. Then, they opted for a trial extubation after about Day 12. Within about 45 minutes trial extubation failed, but it doesn’t look like they tried really hard. They weren’t trying the BIPAP or the CPAP. They weren’t trying the high-flow nasal prongs. They just thought he’s breathing too fast, he’s breathing too shallow, and he’s getting high blood pressure.  His oxygenation dropped down and then they opted to reintubate him about 30 to 45 minutes after extubation.

Now, that seems very premature to me. Patients after extubation that are struggling, they should go on the BIPAP (Bilevel Positive Airway Pressure) or on the CPAP (Continuous Positive Airway Pressure) to begin with to avoid reintubation because it’s very taxing on a critically patient to reintubate them if you can avoid it.

It sounds to me like they really didn’t have a plan to keep this man off the ventilator. He was getting anxious They could have given him some benzodiazepines like Valium or Diazepam to calm him down so that he could be compliant with BIPAP, CPAP or with high flow nasal prongs, physiotherapy, physical therapy, mobilization. That is all part of the cause of when you extubate someone and take them off the breathing tube and the ventilator so that they can stay off the ventilator. That must be the ultimate goal for any patient in ICU to keep them off the ventilator or get them off the ventilator at all costs.

So, it’s always important that you ask the intensive care team, what’s their plan after extubation, making sure your loved one is staying off the ventilator predictably. There always must be some contingency especially when they’re not sure that extubation will actually work.

Again, from my experience, after having worked in intensive care for over 20 years in three different countries where I also worked as a nurse unit manager for over five years, it is very, very important that you have a plan. High flow nasal prongs, BIPAP, CPAP, cough assist sometimes as well to keep your loved one off the ventilator.

So, that is my quick tip for today.

If you have a loved one in intensive care and you want your questions answered and you want a deep dive into all questions intensive care related. We have a membership for families of critically ill patients in intensive care at intensivecaresupport.org or if you go to intensivecarehotline.com and you click on the membership link there. There, in the membership area, you have 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.

Now, I also offer one-on-one consulting and advocacy over the phone, via Skype, Zoom, WhatsApp, or whichever medium works best for you. I talk to you and your families directly and I also talk to doctors and nurses directly, making sure that you make informed decisions, have peace of mind, control, power, and influence. I ask all the questions that you haven’t even considered asking but must be asked so that you stay in control of the situation.

I also represent you in family meetings with intensive care teams by making sure you have clinical representation in family meetings, making sure you have someone on your team that understands intensive care just as well as the intensive care team does.

Once again, I have worked in intensive care for over 20 years in three different countries where I also worked as a nurse unit manager for over five years. I’ve been consulting and advocating for families in intensive care all over the world for the last 10 years here at intensivecarehotline.com.

Also, we review medical records in real time so that you can get a second opinion in real time. We also review medical records after intensive care, if you have unanswered questions, need closure, or if you are simply suspecting medical negligence but it’s much better to review them in real time so you can make informed decisions in real time.

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

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.

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