Dad is in ICU After a Stroke! What is Considered Progress While on Ventilation? Live Stream!

Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!

This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from our readers and the question was

Why Would the ICU Team Advise Giving Up on Treatment for Our Mom? Help!

You can check out last week’s question by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED”, I am here with a live stream today, where I want to answer your questions if you have a loved one in intensive care. And this is one of the most commonly asked questions for families in intensive care and it’s a question that we get all the time. And today’s live stream is about.

Dad is in ICU After a Stroke! What is Considered Progress While on Ventilation? Live Stream!

Good evening, wherever you are. Welcome to another intensive care hotline and Intensive Care at Home Livestream, where we answer questions for families in intensive care or questions for families who want to take their loved one’s home from intensive care with Intensive Care at Home. And welcome to my weekly live stream.

Now, today’s topic is, “Dad’s in ICU after a stroke. What is considered progress while on a ventilator?” What a great question to ask. And we are answering real questions here from real clients or subscribers to our blog that have these concerns, and I’ll address them today on this live stream.

So before I go into today’s topic, just a few housekeeping issues. You can type your questions into the chat pad. You can also call in live on the show. You are able to take the phone numbers that you can call me on from the description below in the video or below the video, and you can call in live on the show to get your questions answered, or you can just type them in the chat pad and I will get to them. Try and keep them to today’s topic. And if they’re not to today’s topic, but you do have a loved one in intensive care, I will definitely get to them at the end of today’s presentation.

Now, furthermore, you might want to find out, or you might wonder what makes me qualified to talk about today’s topic. So I have worked in intensive care for over 20 years as a critical care nurse in three different countries. I have worked as a nurse unit manager for over five years in intensive care. I have been consulting and advocating for families in intensive care for over nine years now as part of my intensivecarehotline.com. And I am also the founder and managing director of Intensive Care at Home where we provide an intensive care substitution service, a genuine intensive care substitution service at home predominantly for long-term ventilated patients in the home. So that’s a little bit about me, but without further ado, let’s dive into today’s topic.

So today’s topic is, “Dad is in ICU after a stroke. What is considered progress while on ventilation or life support?” Great question to ask. Let’s break this down so that you can understand what is considered progress when someone is on a ventilator with a stroke But once there are intricacies just for a stroke patient in ICU, what is considered progress while on ventilation can be used for many other conditions in ICU. But I’ll explain that as I go along.

So when someone is in an induced coma on a ventilator with a breathing tube in intensive care after a stroke, but even after pneumonia or COVID or COVID ARDS, the goal is to get them off the ventilator for all the reasons that I mentioned on many videos and other blog posts before, such as that the deconditioning is real. When someone is on a ventilator with a breathing tube in an induced coma and they’re not getting mobilized, there’s a lot of muscle wastage pretty quickly, and you want to get off that ventilator as quickly as possible, which is very difficult for someone who had a stroke and is being admitted into intensive care because patients are often paraplegic. Meaning one side of their body is paralyzed as part of the stroke. And that in and of itself is making it more difficult for patients to get off the ventilator. Often they are unable to cough or to swallow as part of the stroke. They sometimes have seizures and they get anti-seizure medication. And therefore on top of the sedatives and the opiates, they also get anti-seizure medication which sedates them even further.

So those are all challenges that come into play when someone is having a stroke, irrespective of whether the stroke is an ischemic stroke, meaning a thrombus has caused an oxygen deficit to the brain. Or whether it’s a hemorrhagic stroke, meaning a vessel in the brain burst and/or popped and caused the bleeding stroke. The symptoms are often the same.

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And when someone is in an induced coma and on sedation with a stroke in intensive care, they often started out on controlled ventilation modes such as SIMV, (Synchronized Intermittent Mandatory Ventilation) or PRVC, (Pressure Regulated Volume Control Ventilation). So both of those ventilation forms are controlled. What that means is they’re getting a set breathing rate per minute from the machine, 10 breaths per minute, 15 breaths per minute delivered from the machine, and then the trigger is set so that a patient can trigger on top of those mandatory breaths so that they can trigger breaths spontaneously. If they are in an induced coma and sedated, it’s unlikely that they will trigger extra breaths. If sedation is lowered, chances are higher that they will breathe on top of what is a mandatory breathing rate per minute.

If the stroke is severe, that potentially the respiratory or the breathing center of the brain is impacted, chances are that they’re not breathing. So there are a number of factors that come into play. But for today’s presentation, so that you understand the concept, let’s look at a scenario where someone is slowly waking up, and someone is making efforts to take extra breaths.

So let’s just say for argument’s sake, the patient is ventilated with an SIMV mode with a rate of 15 mandatory breaths per minute. They’re being delivered by the machine every minute and the patient is breathing another three breaths per minute on top of that. So one could argue that one could reduce the rate from 15 down to 12 or even down to 10 and let the patient trigger extra breaths. That would be an ideal scenario. If that happens and the patient doesn’t get tired or exhausted, that could get the patient towards weaning off the ventilator.

But from experience, depending on the patient’s age, premedical conditions, patient fitness level, and all of that, it may not last very long and they might get tired quickly, and all of a sudden they start breathing against the ventilator or against the respirator and patients have to be re-sedated. It’s a bit like two steps forward, one step back, and they’re too weak to progress on that ascension, if you will, where they can take more and more steps to be weaned off the ventilator.

So in the ideal world, the patient starts out with a breathing rate of 15 breaths per minute delivered by the machine, the patient doesn’t have to do any work, and then the rate gets dropped down to 12, the patient breathes the other three breaths that are needed spontaneously. You drop it down to 10, patient keeps breathing five breaths per minute spontaneously, and then you wean it down all the way down to zero and then the patient starts breathing with minimal support from the ventilator. That would be the ideal scenario.

But even with that ideal scenario in mind, there are some obstacles that need to overcome. For example, to check whether ventilation is appropriate and sufficient for a patient, one needs to check arterial blood gases. One needs to check oxygen levels in the blood, one needs to check CO2 levels or carbon dioxide levels in the blood. One needs to check oxygen saturation, one needs to check the volumes on the ventilator. IE (Inspiration Expiration), for simplicity, if a patient is 80 kilos, they should be breathing between 7 to 10 mils per breath per kilo. So let’s just work with 10 mls per kilo to keep things simple. For an 80-kilo person, that means 800 mls per breath. So again, if your loved one is 80 kilos and their spontaneous breaths are 400 mls instead of 800 mls, it’s a very high chance they’re under-ventilated. And you can then again, determine whether they’re under-ventilated or not in an arterial blood gas. So your loved one should have an arterial cathete or an arterial line in their wrist or in their groin to get arterial blood gases, to have the ability to check arterial blood gases.

And if they’re under-ventilated, chances are that PO2 (Partial pressure of oxygen) levels in the blood are low, or PCO2 (Partial pressure of carbon dioxide) levels in the blood are too high. So they need to be within a certain range, of course. And then there are mechanisms for how this can be managed. Let’s just say someone is breathing spontaneously and they’re in a CPAP or pressure support ventilation mode, which is a spontaneous ventilation mode, and their volumes are too low, their tidal volumes are too low, their under-ventilated. There are ways to manage that without putting a patient back into a controlled mode such as SIMV or PRVC.

You could, for example, increase the pressure support. A pressure support that I’ve seen where patients can be taken off the ventilator is around eight centimeters of water. Anything above that, it can be difficult to take a patient off the ventilator. But if you have eight centimeters per water, a PEEP (Positive End Expiratory Pressure)of five, and adequate tidal volumes for a patient’s weight, like the 800 for a patient with 80 kilos, then you have a very good chance that this patient will succeed in being weaned off the ventilator and having the breathing tube removed, also known as extubation

So, for a patient with a stroke, however, there are other obstacles as well. So whilst this is a fairly straightforward scenario for someone without a stroke, for someone with a stroke, it might not be as straightforward. What do I mean by that?

So again, like I mentioned, depending on where the stroke center of the stroke is, is the respiratory center affected? Also, if you then extubate someone, normally what happens is, if someone doesn’t breathe, CO2 (Carbon dioxide) rises in the blood, the respiratory center in the brain gets triggered and once starts breathing. And that is often disturbed by a stroke, can be disturbed. So, the respiratory center is not working as it should be after a stroke. So therefore, when CO2 rises to a certain level in a healthy person, they just start breathing and the person with a stroke, they may not start breathing because again, some damage has been done to the respiratory center.

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Other obstacles that can come up for a patient with a stroke to be weaned off the ventilator is that they might be unable to swallow. They might be unable to cough. All of that is necessary to be able to protect your airway. And if you can’t swallow, if you can’t cough, you are unable to protect your airway, meaning you are at high risk of aspiration.

So a patient with a stroke might well be ready to be taken off the ventilator and they can breathe. However, they might not be able to protect the airway. I.e., they can’t cough, they have no more cough reflex or they can’t swallow, they have no swallow reflex, and if they can’t swallow, they are at high risk of aspiration. I.e., saliva could go down into the lungs instead of the stomach causing aspiration pneumonia, and then it would be two steps back again and one has to go back on a ventilator for the pneumonia.

So what are the ways out of this dilemma? Are there any ways out of the dilemma? Let’s just say someone is ready to be weaned off the ventilator. They’re breathing spontaneously in pressure support or in CPAP (Continuous Positive Airway Pressure), but they don’t have a swallow reflex or they don’t have a gag reflex, or a cough reflex. Then patients, unfortunately, need a tracheostomy. They don’t necessarily need a ventilator, but they need a tracheostomy, even though they don’t need the ventilator in sort of the situation that I just described.

And then obviously it needs airway management with suctioning, inner cannula changes, nebulization, tracheostomy changes, and so forth. But I’ll come to that to the maintenance of that a bit later. There are other situations where a patient can’t be weaned off the ventilator at all and they need long-term ventilation after a stroke . It’s not many patients, but there are somewhere they might be on CPAP or on pressure support, and they might be on minimal settings such as aid of pressure support, 10 of pressure support, 5 of PEEP, but they’re just not quite there yet to have 24 hours off ventilation. And then it could come to a scenario where they might be off during the daytime and then they may need to go back on the ventilator overnight to have a rest. Those scenarios exist as well.

So how can one maximize outcomes in a situation like that? Because that’s what we’re all about here. We want outcomes. So one thing that I’ve certainly seen in my decades of working in ICU is you need to start mobilizing patients fairly early on if you can, sitting them on the edge of the bed, stimulating them, getting them out of the induced coma as quickly as possible so that they can be woken up and that an accurate assessment can be made. What their neurological function is, and their real neurological function is often masked in the beginning because they’re in an induced coma, they’ve been on sedation, they’ve been on opiates, they’ve been on propofol, they’ve been on Midazolam or Versed, they’ve been on morphine or fentanyl for pain management, or they’ve been on Precedex for sedation and pain management.

And they’re often also on medication such as Phenytoin or Keppra to manage any seizures that might come up. So it’s a very, very tricky situation. Waking up patients after a stroke and induced coma and getting them off the ventilator. I would say from experience, it’s actually fairly difficult overall. And again, they might be able to get off the ventilator, but they need a tracheostomy down the line because they can’t swallow, they can’t cough.

So how can you maximize outcomes? You can maximize outcomes definitely through early mobilization, early physiotherapy, early physical therapy, and early breathing exercises. And I vividly remember the patients that we mobilize in ICU early, even with a breathing tube, and you might say, oh, you can’t mobilize patients with a breathing tube. Well, you can, you just need to do it. There are so many ICUs that I’m talking to as part of our consulting and advocacy, and I’ve talked to ICUs all around the world, and there’s just this complacency nowadays that patients no longer get mobilized. And one could argue, I’m an old-school nurse, who did my training in the 1990s, but mobilization was part of nursing training, and it was drilled into you that this is part of excellent nursing care. And I think it’s disappeared, unfortunately. And I do believe that outcomes will get worse and worse.

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But I clearly remember even maybe 10 years ago, we were mobilizing stroke patients in ICU. Even with a breathing tube, you have to secure the airway and it takes two or three people to mobilize. It takes bloody hard work. But that’s just the reality. It takes hard work. And one day you might start with five minutes of mobilization because that’s all a patient can tolerate, and the next day you can do 10 minutes, and the day after you can do 15 minutes. I’m not suggesting here that there are quick wins, but there are wins if you are persistent and if you keep working hard.

And also this is very important, especially with patients after stroke that are paraplegic, who need to start with early mobilization. One side of the body is often paralyzed because of the stroke. So start with early mobilization, start moving that paralyzed arm, start moving that paralyzed leg, keep talking to patients, encourage them to do things, and help them to go from A to B. And it’s often a painful process. It’s a step-by-step process with no quick wins, unfortunately. But this is how people get better and can take weeks. It can take months. I’ve seen stroke patients in ICU for many weeks, sometimes for many months. It’s unfortunate, but that is just the reality.

So just to recap here, in an ideal world, patients go from a controlled ventilation mode, SIMV (Synchronized Intermittent Mandatory Ventilation) or PRVC (Pressure Regulated Volume Control) to a spontaneous ventilation mode such as CPAP, pressure support, ventilation modes, and if they can obey commands, if they’re neurologically intact, i.e., they can follow commands like squeezing fingers, poking out their tongue, wiggling toes. Pupils are equal and reactive, which they sometimes aren’t after a stroke.

Then you can progress to extubation, assuming there’s a cough reflex there, a gag reflex there. That is when patients can be extubated. Another thing that I have seen, and I don’t know why it is, to be honest with you, but I have seen after stroke as well, is that sometimes patients can’t be extubated because they’ve got airway swelling. That means they might be ready to be taken off the ventilator, and they might be able to breathe spontaneously, but if their throat is swollen when you take the breathing tube out, there’s a risk of the throat blocking off because of the airway swelling. Now that can be treated with adrenaline, nebulizers, or steroids, but needs to happen a few days before extubation and the risk that the airway is blocking still fairly high.

So other things that are important when it comes to extubating a patient after a stroke, for example, are things like suction. Okay? So what do I mean by that? For example, if a patient can’t cough or has a limited cough, a limited gagging reflex, patients need to clear the airway with suctioning. And that’s often done by the nurse or by the respiratory therapist to clear the airway.

And that is one of the reasons that if patients can’t cough, can’t clear their secretions, can’t clear their saliva, that’s when they often end up with a tracheostomy, even though they don’t necessarily need a ventilator. As part of what we do with Intensive Care at Home, we have a number of clients at home that sustained a stroke or an acquired brain injury that leads to their inability to clear their secretions and cough. That’s why they need a tracheostomy, and that’s why they need the ICU nurse at home 24 hours a day to manage the tracheostomy and manage the unstable airway.

Also, what is important is that if someone can be extubated or needs a tracheostomy, it’s very important for them to go on to neurology rehab as quickly as possible. You know, got to talk to a neurologist when you have a loved one in ICU with a stroke very early on and see what’s the trajectory going forward. Because the neurologists are the specialists that see the stroke patients over and over again, and they have an idea of what long-term outcomes are. But one way or another, you should never give up hope and you should stay positive, regardless of what the doctors say. It takes time, takes a lot of time. And as I said, as part of Intensive Care at Home, what we do, we have a number of patients at home or had patients at home in the past that had a stroke-acquired brain injury and we looked after them at home. So don’t let the ICU deter you from taking action and getting your loved one home, because it’s possible with Intensive Care at Home.

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So that’s it in a nutshell today. I would love to get your questions now and please type them into the chat pad or you can also call in live on the show and I can answer your questions here live if you like. You don’t have to give your name away, you can just stay anonymous if you want to call in, it’s up to you and I look forward to answering your questions. If you want to type them into the chat pad, the number to call in is below the video in the description. You can call in those numbers.

So while I’m waiting for your questions, I just want to also let you know that I will do another YouTube live stream next week. And the topic next week is how long can you leave with a tracheostomy. That’s the next live stream for next week, same time, 8:30 PM Eastern Standard Time in the US, 5:30 PM on Saturday Pacific Time, which is 10:30 AM on Sunday Sydney Melbourne time. So that’s what’s going to happen next week. What questions do you have? Please don’t be shy. Shoot away your questions. If there are none, then I will wrap this up and the recording will go live as soon as it’s uploaded on YouTube and you can watch today’s presentation there.

Now, I also offer one-on-one consulting for families in intensive care over the phone, via email. We also have a membership for families in intensive care at intensivecaresupport.org. So we have a membership for families in intensive care at intensivecaresupport.org, where we help you with your loved ones in intensive care online. But you can also upgrade, as I said, if you wanted to talk to me personally as part of the one-on-one consulting and advocacy.

I participate in family meetings over the phone, and over Zoom, to help you get the outcomes that you want. Because, the biggest challenge for families in intensive care, is simply that they don’t know what they don’t know. They don’t know what questions to ask, they don’t know what to look for. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. And that’s the biggest challenge. And that’s where I can help you take control of your loved one situation in intensive care because it’s so daunting, it’s so overwhelming, and you feel like you have no power, no control, no influence, and no peace of mind when it comes to dealing with intensive care teams. And that’s where we can help very, very quickly.

I would also appreciate if you could give this video a thumbs up, share it with your friends and families, and subscribe to my YouTube channel

for regular updates and tips for families in intensive care. And again, I’m doing weekly live streams here where I answer your questions live. You can also comment below on what questions you want answered next, or what topics you want.

There’s a comment from Poquott Life Matters. I’m not sure whether I’m pronouncing this correctly. Once again, you are an outstanding individual. Do you help families when their loved ones are no longer in intensive care?

Yes, we do. That’s a great question. So we help families in a number of ways when they’re no longer in intensive care. The first way we help families when they’re no longer in intensive care is by providing Intensive Care at Home. So we facilitate a discharge from ICU to home predominantly for long-term ventilated patients with tracheostomy adults and children. That’s one way how we help families when they’re no longer in intensive care. Another way we help families that are no longer having a loved one in intensive care is by reviewing medical records for example. So we have families coming to us and they want to know, has there been any foul play in intensive care? I don’t think the intensive care teams have done all the right thing. I think there has been medical negligence and we review medical records there. We’ve also helped families with some bereavement after intensive care. We’ve definitely done some counselling there.

So that’s in a nutshell how we help families outside of intensive care. The biggest part of that is definitely Intensive Care at Home, especially here in Australia, Melbourne, Sydney, Brisbane, Perth. You’re in New York, right. Why don’t you tell me more about your situation, Poquott Life Matters? Maybe I can point you in the right direction or I can share with you how I can help you because I’m pretty sure I can. It sounds to me like your loved one is no longer in intensive care. And if you are in New York and you’re looking for Intensive Care at Home services, I might be able to give you a contact there. Tell me about your situation. And I’m pretty sure I will be able to point you in the right direction one way or another.

There is a lot of aftercare needed after intensive care. Whilst our area of expertise is really intensive care. There are so many follow-on services that are missing when people leave intensive care because it’s such a traumatic experience that there is the need for numerous other services to tie in with what we are doing. But we haven’t seen many other services providing sort of aftercare, and we are simply too busy providing that aftercare level overall. And again, it’s also not our area of expertise really.

I’ll give you the phone number. You can call in on 415-915-0090. That is again U.S., 415-915-0090. Do you want me to repeat that again? You can call in on 415-915-0090. And I’m looking forward to your call. So is there anyone on this call? Right? Okay. Yeah, just call in. I’m here. The line is on. Is there anyone on this call or on the livestream now who also wants to know about stroke? Okay.

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Patrik: Hello, you’re speaking with Patrik.

Poquott Life Matters: Hi, Patrik. This is Poquott Life Matters.

Patrik: Oh, yes. I was talking to you on the live stream, wasn’t I?

Poquott Life Matters: Yes, yes you are. How are you?

Patrik: I’m very well, thank you. How are you?

Poquott Life Matters: Oh, hanging in there. It’s been a long journey.

Patrik: How can I help you?

Poquott Life Matters: So, this is the situation. My partner, he was infected with a very rare virus, the Tick borne virus. And December 2020 had started, he was on a ventilator for quite some time, maybe 40 days, but they did do a tracheostomy in the beginning of about a week after his full ventilation. And then they weaned him into a trach and supported by the ventilator. And so that was in over a year ago. And now he’s in a skilled nursing facility. And all year he wasn’t on a ventilator. He arrived at this facility a couple of months ago, they put him on a ventilator and now they’re weaning him off. I mean, he’s off during the day, but at night he is on a ventilator, with the CPAP settings, because they do not have continuous pulse ox monitors, which is, I cannot even believe it.

Patrik: Wow. Wow. That’s dangerous.

Poquott Life Matters: Yeah, it’s frightening. And he was in two previous facilities before, and I can’t get into what happened there, but now he’s in the third one. And they did have pulse ox monitors, which was fine. But this new facility that he’s in, they don’t. So when I spoke with the pulmonologist, he’s concerned because he’s very contracted with the virus. He has meningeal encephalitis to begin with, and he hasn’t gotten any proper medical care. I mean, it is in New York.

Patrik: Yeah.

Poquott Life Matters: You hear about nursing homes all the time. I’m sure even on –

Patrik: All, every day, every day we’re getting-

Poquott Life Matters: Yeah, exactly. And there’s a shortage of not only staff, but there’s also shortage of transport. He hasn’t seen a neurologist in over a year. I’m fighting daily for proper care, and at this point, I’ve made a decision that I want to take him home, because of the care that he is getting there, I can give him the care at home somehow. I need to figure it out. And so that’s the situation. And they’re coming actually, Wednesday, a nurse is coming to assess him whether I can bring him home, and what they can provide me for his care. But I’ve been following you, believe it or not. And I really have to thank you. Because when he was first sick, it was during COVID and I found you because I was searching and Googling and families don’t have a place to go. And you have been a godsend. I cannot say it enough to you. You’ve been a godsend. I never called in because I was just so overwhelmed and that you were in Australia, but I’ve learned so much.

And then I can’t thank you enough for getting through such a difficult time. And now that I found that you have the live streams, I listened last week and this week, and as you were talking about coming home, and I guess next week is that session, but can you help me here in New York?

Patrik: Yes. I might be able to help you in New York. So there is a gentleman, I don’t want to talk about him, don’t want to give away any names on the live stream.

Poquott Life Matters: I can understand that.

Patrik: But, if you email me after this call, I will give you a phone number. There is a gentleman In New York who does similar things to what we are doing here in Australia. He’s not a healthcare professional, but he’s got a network of healthcare professionals. And I know for a fact that-

Poquott Life Matters: I prefer that, because I have to tell you, our healthcare professionals now, I see them as substandard after dealing with them for a year and a half.

Patrik: Right. That’s very disappointing. Very disappointing. But it’s also the reality of the environment, unfortunately.

Poquott Life Matters: Patrik, when in the beginning, I couldn’t see him for months because of everything was locked down in COVID. But he was in ICU, and in New York it’s two patients to one nurse. Sometimes his ICU nurse, because he was in neuro ICU, you know, there was one nurse to one patient, and he developed a stage four, probably 12-inch bed store on his sacrum.

Patrik: Oh my goodness.

Poquott Life Matters: And I heard you’re talking earlier about the mobilization, which clearly did not happen. And it’s very disturbing because in ICU, when you’re two patients to one nurse, how does that happen? It’s upsetting.

Patrik: It’s just terrible. Just terrible. It’s upsetting. A lot of senior staff, whether it’s in the U.S. or here, have left the industry.

Poquott Life Matters: Oh, they have.

Patrik: Have left the industry burned out. Had enough.

Poquott Life Matters: Yeah, it’s very sad.

Patrik: It’s very sad. All these skills and years of expertise and experience have left the industry, never to be replaced.

Poquott Life Matters: Correct. And the new people coming in, they don’t have that same heart, I want to say. They don’t.

Patrik: No, they don’t. And also they’re lacking leadership from the people that have left.

Poquott Life Matters: Sure, sure, sure. It’s a very, very sad situation.

Patrik: Vicious cycle. A vicious cycle.

Poquott Life Matters: Yeah. Yeah. Very sad.

Patrik: But look, in order to take some practical steps, now I’m in the home care business, of course. Just as I’m in the intensive care business, you will need to have a lot of support to take your partner home. I’m telling you from experience, and this is not to be negative or-

Poquott Life Matters: Oh, I understand. You’re not telling me something, Patrik, that I’m not facing. I understand.

Patrik: Because I’m telling you that from our experience here, if you don’t have 24-hour ICU nurses, the risk for a medical emergency to happen and patients potentially dying at home is real. We’ve seen it. And again, I’m not trying to be negative here. I’m very realistic about the risks and how you need to manage it. But that’s also why I think it’s a good idea. If you can speak to my contact in New York. Because he would be aware of the risks.

Poquott Life Matters: I will. Most certainly will. So, what should I do next?

Patrik: Yes, I’ll tell you what you can do next. Can you send me an email to [email protected]?

Poquott Life Matters: Okay. I will.

Patrik: If you send me an email to [email protected], then I will email you my contact in New York and you can contact him. I’ll let him know that you will contact him. He’s in Brooklyn.

Poquott Life Matters: Oh, okay.

Patrik: And hopefully he can help you.

Poquott Life Matters: Okay. I’m hoping he can.

Patrik: If I may just ask out of interest, why did you not try and get your partner home earlier? Is it just simply because you’ve been overwhelmed?

Poquott Life Matters: Well, originally I was hoping that I can get better care for him as far as a doctor. I don’t have a special vehicle. I know the transport is limited. So I was very, very concerned about his bedsore. At one point he was hospitalized because one of the facilities did not take care of it. He developed sepsis through his body and we almost lost him. So that was a major concern for me, and I was afraid of that.

Patrik: Fair enough.

Poquott Life Matters: And that’s probably the biggest one. And I was hoping that he would get better care. But it seems one of the PAs for one of the doctors in the facility, he is now actually said to me, you can’t expect a nursing facility doctor to take care of you. Take care of him. And I’m like, “What?” I mean, this is what you face. And, I just expected normal care. I didn’t expect anything over the top. But you can’t even get that from some of these doctors in these nursing facilities here.

Patrik: Right. And this is why, again, if you followed my content for a while, this is why we are recommending in the first place that no one with a tracheostomy or a ventilator should leave ICU in the first place. Unless you can link in with a service like Intensive Care at Home.

Poquott Life Matters: Exactly. I understand.

Patrik: It’s terrible what’s out there. It’s absolutely shocking.

Poquott Life Matters: Oh, I’ve lived it. I could write a book about what… And the sad part here in New York is, you go to all departments of this, department of that, department of this, and it’s a dead end. Everywhere you go there’s nobody who really cares. And it’s, you hear, well, that’s not mine. Go to this one, go to that one. Go here. And in the end, you’re nowhere. It’s very, very sad.

Patrik: Yeah. And I would imagine the nursing facility where your partner is at, I can only imagine it would be very depressing for you to watch this.

Poquott Life Matters: Yeah. It’s beyond depressing. Nobody can imagine. Unless you walk in those shoes and you have to bite your tongue because a lot of times retaliation exists. And it’s a vicious, vicious, vicious cycle. Vicious cycle. It’s very, very sad.

Patrik: And I can tell you that one of your biggest challenges, and it’s a challenge that’s facing the industry as a whole, is if you can set up home care, will you find the staff who’s going to pay for it? Who will oversee and manage the care? They are your next challenges.

Poquott Life Matters: Yeah, no, I understand that. And that’s again, another difficult challenge.

Patrik: But I’m glad you’re-

Poquott Life Matters: But I’m not giving up.

Patrik: No, no, no, no.

Poquott Life Matters: And never. And even one of the original ICU doctors, he still stays in contact with me. He is a diamond. And he was my encouragement as well. He would say, “Don’t give up. Don’t give up.”

Patrik: Good.

Poquott Life Matters: He set you back. And I wish there was a place that families who… Especially he has a very rare disease now. And that families can go to for just that emotional support. I mean, yes, we have you with ICU, but on the average, now in a nursing facility, there really is no place for a family to go no to. You are alone. And even if your friends and family members, sometimes it’s a year and a half, they’re tired. So you go through all this emotion and you are always feeling alone.

Patrik: Yeah, I can imagine. I can imagine.

Poquott Life Matters: But, I’m strong and you helped me through it. I have to tell you that. And there were times that I was so overwhelmed, that didn’t listen. But for the most part, I know I’m repeating myself, but you’ve just made such a big difference in my life. And I recommend to anybody all the time. Even some of the hospital nurses, I tell them, “Listen, please go there. Listen.” And hopefully more people will come. And you just need to know that you’re helping a lot of people.

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Patrik: Oh, that’s good to know. I really appreciate that. And there’s a credit to my team in the background as well. I’m not a one-man band.

Poquott Life Matters: Of course. There’s people, of course.

Patrik: There’s people helping me to pull this off. Can I ask you, when you email me, I will send you a link to an interview that I’ve done many years ago actually, because there was this gentleman in Boston, Charlie Atkinson, and I know he doesn’t mind me mentioning his name here. He was in a fairly similar situation than your partner, after some sort of virus. And he was in hospital and LTAC (Long Term Acute Care) for at least 12 months, and he managed to get off the ventilator. I need to send you the link to the interview that I’ve done. It’s quite inspirational. Charlie at the time was in his early eighties.

Poquott Life Matters: Wow.

Patrik: Yep. A very sharp individual. I will send you a link to that interview because I think you should listen to it, and I think you should also get your partner to listen to it.

Poquott Life Matters: I will.

Patrik: I also believe that, Charlie, I don’t know what’s happened to him. I haven’t spoken to him for a while, but he’s in Boston. I would believe that Charlie would be someone that’s happy to talk to you.

Poquott Life Matters: Wonderful.

Patrik: Because, again, that moral support is critical.

Poquott Life Matters: It’s unbelievably critical of just getting through and all the highs and lows and feeling alone. Like I said before, just feeling alone.

Patrik: Yeah. Yeah. So look, the next step is please send me an email.

Poquott Life Matters: I’ll email you. Yes, I will.

Patrik: Do you want me to repeat the email address again?

Poquott Life Matters: Nope. I got it. [email protected].

Patrik: That’s the one. That’s the one. And I look forward to hearing from you, and then I can give you my contact in New York and hopefully, he can help you.

Poquott Life Matters: Oh, wonderful. Thank you, Patrik.

Patrik: It’s a pleasure. And thank you for dialing in. Very nice to talk.

Poquott Life Matters: I couldn’t. It’s funny on my phone, I could see you and I had the live chat box, but I couldn’t scroll underneath the video.

Patrik: Right. That’s okay.

Poquott Life Matters: And I was like, “Oh God. No.”

Patrik: That’s okay.

Poquott Life Matters: But thank you.

Patrik: It’s a pleasure. It’s a pleasure. Thanks again for dialing in, and I will look forward to your email.

Poquott Life Matters: I’ll send it right now.

Patrik: Thank you. Thank you so much.

Poquott Life Matters: Okay, Patrik. Thank you. God bless you.

Patrik: Thank you. Bye-bye. Thank you. Bye.

Poquott Life Matters: Bye-Bye.

All right. So you’ve listened to this and you know that you can hear that there are people out there hurting, because of what’s being offered in terms of aftercare, after intensive care. It’s just not enough, whether it’s for the patients or for the families as we’ve just witnessed here on this calling. Now I need to wrap this up for today.

I want to thank everyone for coming onto the livestream. I want to thank you for calling in for your questions, and I look forward to seeing you again next week. Around the same time. Like the video, subscribe to my YouTube channel for regular updates for families in intensive care. And click the notification bell and share the video with your friends and families. And 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 or send us an email at [email protected].

Thank you so much for watching. This is Patrik Hutzel from intensivecarehotline.com and intensivecareathome.com and I will talk to you very, very soon.

Take care, everyone. Thank you.

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