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If you want to know when it’s okay for your loved one in intensive care to move to a step-down ICU, stay tuned. I’ve got news for you.

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

So currently, we are working with a client who has their 76-year-old mother in intensive care after a cardiac arrest with a hypoxic brain injury. She ended up with a tracheostomy on a ventilator, and she has been hemodynamically stable. Now, the intensive care team wants to move her to a step-down ICU. Our member and client is asking whether that’s the right next step for their mother.

Now, here is what you need to know about step down ICUs, it’s the term that’s being used mainly in the U.S. for sort of more of a high dependency environment. In other countries such as the U.K. or Australia, it’s not called step down ICU. It’s more called like a HDU, like a high dependency unit, or sometimes it’s also called like a progressive care unit. In any case, it’s sort of a slightly lower level of ICU care that’s being provided in the step-down ICU.

So, from my experience, and bear in mind I have worked 25 years in critical care nursing in 3 different countries where I worked as a nurse manager for over 5 years in intensive care, and where I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com where we have saved countless lives for our clients and members in intensive care. You can verify that on our testimonial section at intensivecarehotline.com and you can verify that on our intensivecarehotline.com podcast section.

So, coming back to our question, when is it okay to go to step down unit? It’s okay to go to step down unit when your loved one is hemodynamically stable and is on their way to recovery, but they may still be ventilated and may have a tracheostomy.

Now, what is important if your loved one is going to a step-down ICU, questions that you should be asking for is, is it the same team looking after your family? Because it is important that your loved one is being looked after by the same team. It’s all about consistency of care. It’s all about having a team around your family member that knows your family member well.

So, once again, it depends on stability of the patient, whether they have a stable blood pressure, heart rate, and oxygen levels are fine. Ventilator settings is also something that needs to be looked at. How much ventilator support is your critically ill loved one now? Is it lower oxygen requirements, is it less pressure support, or is it high FiO2 (fraction of inspired oxygen) or high oxygen requirements because then it might be too early to go to step down ICU.

Also, how much intervention does your loved one need when they are going to step down ICU? Because once again, generally speaking, in an ICU there might be many or some emergency interventions. You don’t want to have any emergency interventions pending if you’re going to step down ICU.

Also, what is the original reason for the ICU admission, i.e. infection, respiratory failure, is it improving? Is it resolved? Then, transitioning might be appropriate.

Also, it comes down to hospital policies as well because every hospital has different criteria for step down ICU admissions. However, my extensive experience in critical care nursing it is, generally speaking, the same. Like I explained, hemodynamic stability, ventilation, or lower ventilation settings with a view of ventilation weaning. Then, it also comes down, of course, to the availability of beds and staff in the step-down.

I hope that answers your question, but what is also important is that there is a plan, a care plan to wean your loved one off the ventilator and the tracheostomy. If there’s no plan, such as mobilization, a weaning plan, physical therapy, then the environment really doesn’t make a difference. Weaning your loved one off the ventilator needs to start in ICU and needs to be continued in a step-down ICU.

So, I hope that helps you understand when your loved one is ready to go to a step-down ICU and what needs to go hand in hand. I can’t stress enough if it’s the same team looking after your mom or after your family member to have that consistency of care, that holistic care aspect.

Now, we have helped hundreds and hundreds of members and clients over the years here at intensivecarehotline.com and we can do the same for you. That’s one of the many 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, and 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.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecareholine.com if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, 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 as it relates to your loved one in intensive care. You also have exclusive access to 21 e-books and 21 videos that are only exclusively accessible to our members. All of that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets 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 in intensive care, click the like button, click the notification bell, share this video with your friends and families, and leave your comments below what you want to see next, what questions and insights you have.

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.

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.