Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
Now, yesterday, we had an inquiry from a client who said that their loved one has been diagnosed with COVID, went into the hospital, got diagnosed with COVID pneumonia, then, ended up on a hospital floor, and initially on a hospital ward initially ended up on high flow nasal prongs, which is, humidified oxygen and also gives a little bit of a PEEP (Positive End-Expiratory Pressure). And I’m not going to too much detail into PEEP. Anyone familiar with ICU, even who had a loved one in ICU with the ventilator probably knows by now what the PEEP is. And I’ve blogged about this in numerous videos and blog posts. You can look it up on our website, just type in PEEP into the search box.
Anyway, the client ended up on a hospital floor, hospital ward, with high flow nasal prongs and then needed BiPAP. And then once they were on BiPAP, their oxygen levels and PEEP levels and pressure of support levels were going up and to the point where they could barely remove the BiPAP mask any longer, because they were desaturating. Their oxygen levels dropped so quickly that they literally were at the point of either intubation in ICU or potentially dying. And when I say intubation in ICU, I mean breathing tube in their mouth, in the lungs, hooked up to a ventilator. That’s the difference between BiPAP with a mask or the breathing tube on the ventilator.
Now it turned out that the client ripped off their BiPAP mask because it’s very uncomfortable and it wasn’t detected by the nurses quickly enough on the hospital ward and the client then ended up with a respiratory arrest and then ended up in ICU with a breathing tube in their mouth, on a ventilator, in an induced coma.
Now, why am I sharing this? You might think, “Well, this is happening all the time”. BiPAP on the ward, what’s the big deal? Well, it is a big deal because BiPAP with a mask should never be done on a hospital ward. You can do BiPAP on a high dependency unit or maybe on a step down unit, but you can’t do it on a hospital ward. I’ve never seen it done successfully. The risk of someone going into ICU is too high because really BiPAP needs to be managed by intensive care nurses by intensive care doctors, potentially by respiratory therapist, if you are in the US or in Canada, right? So the risk of someone being on BiPAP and deteriorating quickly, and it can’t be managed on a ward on a hospital ward is real as I’ve just shown you in this example. And it can really be deadly.
Now the challenge at the moment is still, what I think is the end of a pandemic, but, ICUs are full they’re overcrowded. So that means some hospital areas need to start BiPAP because there is no space in the ICU, no staff, no equipment, whatever the case may be. And that’s why those unsafe practices might be put in place in the first place. So it is really important that you understand the hospital environment, how they take, which patients need to be in ICU. And I can assure you a patient on BiPAP, especially on high oxygen levels, which was the case here. We’re talking about 80 to a hundred percent of oxygen with high PEEP levels needs to be in ICU full stop. They need to be monitored for arterial blood gases to see whether the BiPAP ventilation is effective or not.
They need regular chest x-rays. They need ICU doctors and ICU nurses listening to their chest regularly to again, look whether the air or oxygen is going into the lungs. Tidal volumes need to be assessed, minute volumes need to be assessed. And that is the specialist skill of an ICU nurse, ICU doctors, ICU respiratory therapists. And that just simply doesn’t happen on the ward. Those signs have probably been missed, that volumes weren’t going in. Patient was probably getting drowsy. Those are all things that will be monitored in ICU very closely, so that those things don’t happen in the first place.
So that is my quick tip for today, that when someone is on BiPAP, they need to be in ICU. The exception is that, for example, if you go to our sister site intensivecareathome.com, you will find that here we are providing a service for intensive care patients at home for long term intensive care patients at home.
That includes BiPAP. But again, we are sending intensive care nurses into the home where it’s safe to provide one on one nursing care for someone on BiPAP because we’re basically bringing the intensive care unit into someone’s home.
So that is my quick tip for today.
If you have a loved one in intensive care, go to intensivecarehotline.com, call us on one of the numbers on the top of our website. And if you enjoy this video, like the video, comment below what you want to see next, subscribe to my YouTube channel for updates for families in intensive care and click the notification bell. And you can also send us an email to [email protected] with your questions.
This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.