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Quick Tip for Families in Intensive Care: Can My 65 Year Old Mother in ICU be Extubated? Two Weeks Intubation on ACV (Assist-Control Ventilation) & Avoid Tracheostomy

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

So, currently we are working with a client who has the 65 year old mother in ICU for the last couple of weeks, initially with cardiac arrest, supposedly hypoxic brain injury, but she has woken up now. She’s now at the point where she is in a controlled ventilation mode, in an ACV (Assist-Control Ventilation) mode, with a rate of 15 breaths per minute, with a PEEP (Positive End-Expiratory Pressure) of 5. But the minute they reduce the rate, the minute they try to do some spontaneous breathing trials, she’s failing miserably and she’s becoming hypercapnic. Hypercapnia means that she’s retaining CO2 or carbon dioxide, and if patients are retaining CO2 or carbon dioxide, they become drowsy and their breathing is simply not optimized.

The good news about this lady is she’s fully awake. She’s even doing exercises, so the ICU is doing all the right things in that aspect. They’re doing exercises with her, she’s doing physical therapy, and she’s even marching. All this to get her out of bed, but she’s simply not.

Now, the client is asking, should they give consent to the tracheostomy? The ICU is saying that, “Oh, she should have a tracheostomy and the PEG tube (Percutaneous Endoscopic Gastrostomy) and then go to LTAC (Long-Term Acute Care).” Our advice is that, she does need a tracheostomy because she’s simply not ready to be weaned off the ventilator. It’s now about 14 days and clearly, all research suggests that the tracheostomy needs to be done after 2 weeks of being unable to wean a critically ill patient off a ventilator.

She’s off sedation and opiates many days ago. Like I said, his mom is fully awake and she’s doing all the right things. She’s just for whatever reason, not ready to wake up. They’ve done all the neurological tests. They can’t find anything. They can’t really diagnose at this particular point in time why she is retaining carbon dioxide or CO2. It is a mystery so far.

The only thing that I said to the client is they need to find out if she’s potentially got sleep apnea. She hasn’t been diagnosed with it yet, because many patients with undiagnosed sleep apnea retain CO2 and become hypercapnic. So, the moral of the story is that, yes, they should also insist on the ICU having a weaning plan. The ICU having physical therapy plan so she can get stronger, breathing muscle strengthened. They should probably do a sleep study at some point, ruling out whether she’s got any sleep apnea or not.

They’ve done all the neurological tests, like I said, CT (Computed Tomography) scan of the brain, MRI (Magnetic Resonance Imaging) scan of the brain, EEG (electroencephalograph). They’ve even done a lumbar puncture. So, the ICU is definitely doing what they’re supposed to be doing, but the next step is to get on the weaning regime to strengthen her breathing muscles so she could be weaned off the ventilator.

Now, the other thing that’s important here, the ICU is also trying to push for a PEG tube, and this particular ICU is in the U.S. Again, we are strongly advising against the PEG tube. Nasogastric tube will be perfectly fine. She could be weaned off the ventilator without a PEG tube, there’s no need for another type of surgery.

So, I hope that helps you understand, if your loved one is in a similar situation, what needs to happen.

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, and 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 for our clients in intensive care. You can verify in our intensivecarehotline.com testimonial section at intensivecarehotline.com where we have published our testimonials and you can also verify that we have saved many lives for our clients in intensivecarehotline.com podcast section where we have done plenty of client interviews and you can listen to our client interviews there because our advice is absolutely life changing.

Because our advice is absolutely life changing, that’s why we help our clients to improve their lives instantly, making sure they make informed decisions, have peace of mind, control, power, and influence so that they love ones get best care and treatment always. That’s why you can join a growing number of clients and members that we have helped over the many years, hundreds and hundreds of them, potentially thousands of them.

You can join the list of members and clients we have helped over the years because I do one on one consulting and advocacy over the phone, Zoom, 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 can’t afford to get wrong. When I talk to you and your families directly, I also offer to talk to doctors and nurses directly with you 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 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. In the membership, you also have exclusive access to 21 videos and 21 e-books that only are 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.

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Thank you so much for watching.

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

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