Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

Case Study: How We Successfully Advocated to Extubate a Patient in ICU and Avoid a Tracheostomy!

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

So today, I actually want to read out a recent case study where we help a family or a lady to get her husband extubated in ICU instead of getting a tracheostomy.

Here is how we did that. The ICU was adamant that her husband needed a tracheostomy, but the signs were there and when we looked at medical records that he’s probably ready for extubation.

Extubation means the removal of a breathing tube. When someone is in intensive care and can’t be weaned of a ventilator and they are on the ventilator with the breathing tube for more than two weeks, then most literature suggests that the patient needs a tracheostomy.

I can confirm that I have worked in critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can proudly say that we have saved lives with our consulting advocacy, and you can verify that on our testimonial section at intensivecarehotline.com or you can watch our podcast or listen to our podcast where we’ve done some client interviews.

So, we had a client recently who had their husband in ICU. Like I said, when the client contacted us, she said, “Well, I think my husband is ready for extubation but they’re not moving forward. They want to do a tracheostomy, then want to send him to LTAC.” This is a U.S. based client where patients in ICU often get a tracheostomy and then get sent off to LTAC. LTAC stands for Long-term Acute Care facility.

Now, I’ve made countless of videos about LTAC that LTAC are dangerous. In this situation, we could help the client and how did we do that? So, we looked at medical records, and we also asked the client to send us some pictures of the ventilator, medications that are going in, but we also looked at medical records.

Then, ICU still wasn’t budging. Then we said to the client, “Let’s write a letter to hospital executive”, because often when ICU doesn’t want to change, even though the signs are there that they need to change, you need to go to the top. I argue from having worked in hospitals for so long, a hospital CEO, or hospital executive can’t ignore the complaints of a patient or a family.

So, here is what we wrote to hospital executive with good result because the patient got extubated 2 days later. So, I’ll read out the email that we crafted for the client.

“Dear, Hospital CEO,

My husband, Peter, not his real name, has been an inpatient in your esteemed ICU since the 30th of March 2024. He’s currently intubated and dependent on mechanical ventilation.

I have noticed that in spite of my husband breathing spontaneously yesterday for 2.5 hours on the T-piece or HME filter, he was re sedated overnight with Precedex and fentanyl. Fentanyl in particular, comes with undesired side effects such as respiratory depression, especially in light of the fact that the goal for my husband is to be weaned off the ventilator in the shortest period of time in order to avoid tracheostomy.

Moreover, on top of the chemical restraints, Precedex and fentanyl, the doctors and nurses are physically restraining his limbs. Physical restraints outside of emergency situations are illegal and against the law in Texas,” The client was in Texas.

“Whilst I acknowledge that being ventilator-dependent presents a semi emergency situation, it is reasonable that my husband is free from chemical and mechanical restraints in order to wean him off the ventilator.

The mechanical restraints, in particular, make him very agitated and anxious. It is therefore inappropriate to use chemical restraints to manage the anxiety caused by the mechanical restraints.

One way to improve his anxiety is to have a one-to-one nurse to patient ratio so a nurse can talk to him and calm him down instead of using mechanical or chemical restraints. This is reasonable in the context of weaning my husband off the ventilator.

Furthermore, I have engaged in intensive care nurse advocate who advises me that the weaning plan should be formulated in order to, number 1, wean my husband off the ventilator and, number 2, avoid a tracheostomy.

When looking at the medical records, no weaning plan has been documented. Does that mean your esteemed ICU team is lacking the skills and expertise of weaning critically ill patients off mechanical ventilation?

Moreover, I have not seen a physiotherapy plan for my husband to help wean him off the ventilator. It is evidence-based practice that physical therapy is significantly contributing to weaning mechanical ventilation successfully, and we put a reference in there. Once again, is your esteemed ICU team unfamiliar with best weaning practices?

In light of all the facts above, I trust that your esteemed ICU is taking evidence-based practice into consideration as well as ceases to use physical and mechanical restraints immediately with the goal of the continuation of spontaneous breathing trials and ultimately weaning my husband towards extubation.”

That email later turned the needle. That’s how we help clients.

Before you get negative and you would say it would never work, well, like I said, I’ve worked in critical care for a long time. I know what works and I know what doesn’t work. We’ve gone through much trial and error here at the Intensive Care Hotline to fine tune our advocacy to get the results for clients that they want, need, and deserve. Because we want to help as many families in intensive care as possible, that’s why we created this content here.

But also, that’s why we created the membership for families of critical patients in intensive care. You can become a member there if you go to intensivecarehotline.com and you click on the membership link or 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.

In the membership, you have also exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded, and those videos and e-books will help you to steer this incredibly difficult territory that is intensive care, and this material will help you make informed decisions, have peace of mind, control, power, and influence, and it will help you to get your loved one best care and treatment.

Furthermore, I also offer one-on-one consulting and advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families. I talk to doctors and nurses directly, and once again I ask all the questions to the doctors and nurses that you haven’t even considered asking but must be asked. I help you and your families make informed decisions, have peace of mind, control, power, and influence making sure your loved one gets best care and treatment. Furthermore, I also represent you in family meetings with intensive care teams.

We also offer medical record reviews in real time so that you can get a second opinion in real time and guidance in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].

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 share the video with your friends and families.

I also do a weekly YouTube live where you where I answer your questions live on the show.

Thank you for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.