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Quick Tip for Families in Intensive Care: High-Risk Extubation to BiPAP 70% FiO2 Instead of Tracheostomy! This is How We Help Families in the ICU!

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

So today I want to talk about a success story where we worked with a client few weeks ago or a couple of weeks ago, who had their mother in intensive care for about two weeks on a ventilator with a breathing tube. And the ICU team initially was very reluctant to do a tracheostomy even though we couldn’t really see a way forward without doing a tracheostomy because this lady, after severe pneumonia; aspiration, pneumonia, was up to 100% of FIO2. Sort of hovering between 70% to 100% of FIO2, just for anyone wondering, is that a lot of oxygen? Yes, it is. Room air is 21% of oxygen. The air that you and I breathe in is 21% oxygen. So this lady needed 70% to 100% of oxygen to keep her alive quite literally. And it was touch and go.

PEEP of 10 to 15 and nobody would be doing a tracheostomy with a PEEP of 10 to 15 or with FIO2 (Fraction of Inspired Oxygen) above 40%. So it was touch and go. And after about two weeks of this lady being intubated, slowly her oxygen requirements and her PEEP (Positive End-Expiratory Pressure) came down, but still, she seemed to be very weak, but we then eventually advocated for her to not have a tracheostomy and do a trial extubation.

She did have a trial extubation. She then went on to BiPAP (Bi-level Positive Airway Pressure) with a mask up to 70% of her FIO2 for another couple of days. But then like I say, over and over again, in a situation like that, you need good physical therapy, good breathing exercises, good coughing exercises, mobilization, sitting up –  sitting up in the bed, sitting out in a chair, even if it’s only sitting on the edge of the bed for a few minutes, and that’s what this lady had and yes, it was touch and go for a few days. But eventually, she succeeded in being extubated and the tracheostomy was avoided.

And this is why so many ICUs are trying to rush a tracheostomy rather than looking at it. Ok. Can we achieve avoiding a tracheostomy in the other way, especially in the U.S., when a tracheostomy leads to a transfer to an LTAC (Long Term Acute Care) or to a rehabilitation facility where they’re not equipped to look after ventilation and tracheostomy.

In this situation, it’s a prime example that when ICUs are doing the right things, and when, someone can steer the family in the right direction, the outcomes are really good for patients. But you can’t just follow ICUs blindly because if you do, you are often doomed because they have their own agenda and their agenda is to maximize revenue, to maximize their bed flow, and to minimize long-term stays in intensive care. Because, once someone has a tracheostomy or needs to be weaned off the ventilator long-term, it takes a lot of time, effort, resources, and also know how. And that can be very challenging, but you need to do what’s right for your family member.

And this is what happened when this lady or this client reached out to us. We gave them a second opinion and look what’s happened. You can’t be flying blind when you’re having a loved one in intensive care.

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 to look for. They don’t know what questions to ask, they don’t know their rights and they don’t know how to manage doctors and nurses in intensive care.

And unless someone explains to you what’s really happening in much detail, how does a chest X-ray impact on getting extubated or needing a tracheostomy? How do arterial blood gases impact getting extubated, and needing a tracheostomy? How do medications, and your loved ones  impact on needing a tracheostomy? Not needing a tracheostomy? Moving on to extubation? Removal of the breathing tube and then maybe on to BiPAP? Explaining to families what are the options after extubation? ICUs don’t explain that to you. They think you don’t understand. Unless you’re asking the right questions, they’re not even telling you half of the story, let alone half of your options.

It’s such a highly complex and specialist area that you need to have someone guide you step by step because the devil is absolutely in the details when it comes to treatment in intensive care. You can’t be jumping into conclusions. You need someone to walk you through it, step by step. That’s more objective and doesn’t have the agenda of an intensive care team behind them, and that’s what we do here at intensivecarehotline.com.

So that is my quick tip for today.

Now, if you need help, we have a membership for families of critically ill patients in intensive care at intensivecarehotline.com. Click on the membership link and you can get access there or 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.

I have worked in intensive care for over 20 years in three different countries where I also worked as a nurse unit manager for over five years. And I have been consulting and advocating for families in intensive care all over the world since 2013. Please look up our testimonial section as well as some of the videos and podcasts we’ve done with clients that speak for themselves and confirm the results that we are getting. I can say without any exaggeration that we have saved lives, and many lives over the years. With our consulting and advocacy where intensive care team simply wanted to pull the plug and empty that bed, where we stepped in and said, no, there are other options and of course, there were other options. There are always other options.

I also offer one on one consulting and advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. And I help you working through this difficult situation in intensive care. I also talk to doctors and nurses directly and I ask all the questions you haven’t considered asking, but must be asked when you have a loved one in intensive care so that you can make informed decisions, have peace of mind, control, power and influence.

We also offer medical record reviews in real-time so that you can get a second opinion 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.

Now, I also represent you in family meetings with intensive care teams making sure you have again, clinical representation, you have someone that can ask the right questions and that can stand up for you with the right questions and with the right level of advocacy and all of that you get at the intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send me 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, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

Thanks for watching.

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

Take care for now.