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Quick Tip for Families in ICU: Thank You for Helping My Son on a Ventilator & Tracheostomy to Wean Off High Doses of Sedation & Opiates

If you want to know how to get best care and treatment for your loved one in intensive care on a ventilator with a tracheostomy after lung failure, 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 19-year-old son in intensive care after lung failure. He was on ECMO (Extracorporeal Membrane Oxygenation) therapy for a couple of weeks. He had ECMO successfully weaned off, which is fantastic. Then, he ended up with a tracheostomy instead of a breathing tube because he couldn’t be weaned off the ventilator in a short period of time. So far, that all makes sense.

One of the main goals of having a tracheostomy is simply to reduce and even eliminate sedation and opiates completely. It turns out that this guy reached out to us when they thought something’s not quite right with what the intensive care team was doing, and they thought that he’s on too much sedation and too many opiates. When they reached out to us and said, “Look, can you please check?” He is on a cocktail of hydromorphone, fentanyl, diazepam, ketamine, midazolam, propofol, and Precedex. I was almost gobsmacked and very surprised that this cocktail of sedatives and opiates was being given because for most patients on a tracheostomy and a ventilator, that’s not possible.

If you look at the literature, if you look at the research, if you look at my past videos and blog posts, high doses of sedatives and opiates are unnecessary for someone with a tracheostomy. There are very few exceptions to that. Like I said, the main goal for someone on a tracheostomy is to be weaned off the ventilator as quickly as possible, and you can’t achieve that with opiates and sedatives going in especially at such high doses. It’s counter counterproductive.

So eventually, the family and I got on a call with one of the senior nurses in the ICU and I was asking exactly those questions. I said, “What’s the reasoning and the purpose behind giving all these sedatives and opiates?” and they didn’t really have an answer besides saying, “Oh well, when he wakes up, he gets agitated.” Well, fair enough, because medications such as fentanyl or hydromorphone are opiates, and they’re addictive in nature, that means if you give a lot of them, patients are getting addicted to it. That means when you try to wean them off, patients go through withdrawal process, which might mean they get agitated.

The same is applicable for the diazepam and the midazolam, they are benzodiazepines. They’re also addictive in nature, which means patients also go through a withdrawal. When they get taken away, the benzodiazepines, it’s like taking away the lolly from the child, child starts screaming.

So, how do you manage that? Well, first of all, you manage that by taking it away gradually, step by step, but you also do it early, as soon as the tracheostomy has been done. Sedation and opiates should be weaned off as quickly as possible and sustainably, of course. But it turns out that this young man was on “truckloads of opiates and benzodiazepines” for a couple of weeks, which is way too long. He wasted way too much time. He could be mobilizing now, could be having physical therapy now, could be out of bed. Instead, he’s still under sedation, which is completely unnecessary. There are very few patients that might need sedation and opiates while they’re having a tracheostomy, but it’s far and few in between. Keep in mind and always keep using common sense. Patients with the tracheostomy should not be on opiates or sedation.

Then, two days after, we had the consulting session, and I get a text from the family and says, “Thank you, Patrik, for your advice. The nurses finally listened, and my son woke up. He only now has fentanyl going through his veins, and that has been taken down gradually as well.”

So, it all comes down to getting the right advice. It all comes down to getting that second opinion. It all comes down to asking the right questions. It all comes down to having a professional talking to other professionals and holding them accountable.

The biggest challenge for families in intensive care is that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights. They don’t know how to manage doctors and nurses in intensive care. That’s exactly what this family was dealing with. It’s all about asking the right questions and it’s all about getting to the bottom of things as quickly as possible. That’s how we get results for our clients.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our podcast section at intensivecarehotline.com where we have published and done some client interviews who verify that we have helped them to save their loved one’s life with our consulting and advocacy. That’s why we have hundreds and hundreds of members and clients over the years and that’s why we help you.

That’s 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. When I talk to doctors and nurses directly, like in today’s example, 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 in intensive care, and you can become a member if you go to intensivecarehotline.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. You also have exclusive access to 21 eBooks and 21 videos that only our members have access to. 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, and comment below what you want to see next, what questions and insights here from this video.

I also do a weekly YouTube live where I answer your questions live on a show, and you will get notification for the YouTube live if you are a subscriber to my email newsletter or if you are a subscriber to my intensivecarehotline.com email newsletter. Share the video with your friends and families.

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.

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