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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, “When should the ventilator be removed after a stroke?” And that is assuming that your loved one has gone into intensive care after a stroke and is ventilated with a breathing tube or a tracheostomy after a stroke. So, when should the ventilator be removed? That’s a question we get quite frequently. It’s more of a general question, but let’s break this down today so that you can find hopefully the answer to this question today.

So, when someone goes into intensive care after a stroke, it really depends on the severity of the stroke. Most patients that do go into intensive care after a stroke means it’s quite a significant stroke. So, they might stop breathing or they might even go into respiratory arrest or cardiac arrest depending on the severity of the stroke. They’re often at least paraplegic and they lose the ability to talk, and they need to be intubated for those reasons that I just mentioned. And then, hopefully after a few days off an induced coma, they can hopefully wake up and get weaned off the ventilator, but there’s no guarantee for that. Depending on the severity again of the stroke, whether there’s been significant and long-lasting brain damage. And if that is the case, if patients after a stroke cannot obey commands, that could be an obstacle to getting off the ventilator.  Also, because the stroke is a neurological event, whether it’s a hemorrhagic stroke, so a bleed in the brain, or whether it’s an ischemic stroke, i.e., a thrombus causing the stroke.

The neurological event can cause, as I said, paraplegia can cause the inability to swallow. It can cause the inability to speak. And especially with the swallowing aspect, potentially not working, a tracheostomy might need to be done. For example, in our service Intensive Care at Home and you can find more information at intensivecareathome.com. We have clients at home with a stroke, for example, they are no longer able to swallow, and they have a tracheostomy. They’re not necessarily ventilated, but they’re unable to swallow and therefore they need a tracheostomy. So, even though someone might have the ability to be weaned off the ventilator, if they are no longer able to swallow or to eat, they may need a tracheostomy. And therefore, the next step after the breathing tube for some patients might be to do a tracheostomy and then wean them off the ventilator.

Now, in the ideal world, people can swallow, and can talk, and then, they can be extubated after only a few days in ICU, and they can go on to rehabilitation, of course. Challenges for patients that need a tracheostomy that are not able to wake up and then a weaning process might start after they had a tracheostomy come out of the induced coma. Only then can you really assess someone’s neurological function after they’ve come out of the induced coma. Is the brain working? Where are the deficits? What does the MRI (Magnetic Resonance Imaging) scan of the brain show? What does the CT scan of the brain show? Has an EEG been done? What’s the neurologist saying about the future of your loved one with a stroke in ICU?

So again, if your loved one needs a tracheostomy and can be weaned off the ventilator, that’s great. The sooner the better, of course. But again, if they’re not, if your loved one is not passing the swallowing test, they probably would need a tracheostomy until they can swallow and that may not be the case ever again, it’s hard to say. I am not a neurologist. I’m just talking from my extensive ICU experience for over 20 years in three different countries where I looked after many patients with a stroke in ICU that were ventilated with a breathing tube and also with a tracheostomy. And then also, as I said, with our Intensive Care at Home service, we’re looking after patients at home that have a stroke.

So, that is my quick tip for today. I hope that helps.

Also, again, if you have a loved one in intensive care that has a tracheostomy or is long-term ventilated with a tracheostomy or is off the ventilator but has a tracheostomy and you’re looking for home care, you should be checking out intensivecareathome.com. With Intensive Care at Home, we’re operating all around Australia and all major capital cities and in regional and remote areas. We are NDIS (National Disability Insurance Scheme) funded or our clients are NDIS funded, TAC (Transport Accident Commission) in Victoria, iCare in New South Wales, as well as DVA (Department of Veteran Affairs) funding all around Australia. So, please contact us. But also, if you’re in the U.S., and you are looking for Intensive Care at Home, you should contact us as well.

Now, if you have a loved one in intensive care and you need advice and you need help, please 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] 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, 24 hours a day, again, in a membership area and via email.

If you need a medical record review for your loved one in intensive care, we can do so in real-time while your loved one is in intensive care, and we can give you a second opinion in real-time. Or if you need a medical record review after intensive care, we can help you with that as well. But we strongly recommend having the medical record reviewed in real-time so it’s not too late for you to make informed decisions.

Also, if you are an NDIS participant or you have a loved one that needs NDIS and you need a nursing assessment, please contact us as well. Or if you’re an NDIS support coordinator and you need someone to do a nursing assessment, please contact us as well.

Now, subscribe to my YouTube   channel for regular updates for families in intensive care and Intensive Care at Home, click the like button, click the notification bell, share this video with your friends and families, 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 Intensive Care at Home and intensivecarehotline.com, and I’ll talk to you in a few days.

Take care.