So today I have a question from Angela, who’s one of our clients.

My name is 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 control, power and influence, even if you’re not a doctor or a nurse in intensive care, making sure that your loved one always gets best care and treatment.

So, Today I have an email from Angela who says.

“Hi Patrik,

My mother’s day nurse today is much better. Here’s what she told me. My mom is being fed via a nasogastric tube. She’s off sedation and opiates. Her eyes are open, and when the nurse opens them, she will close them herself. She did agree to try to loosen the restraint on the left hand which was supposedly weaker. During my Zoom call, she reached up for the tube and scratched her head vigorously. I had to yell at her not to pull out the breathing tube. During the call, she also looked at me, moved her legs, and was a little more awake. I tried to get her to speak, but she just looked at me.

How long does it take for the throat to heal? What are some easy words that I should ask for her to say? For babies, often their first words are dada. Would it be the same for adults?

Thanks again, from Angela”.

So, Let’s look at understanding throat recovery and communications in ICU with a breathing tube. So, here’s what I need to tell you, Angela, this is really encouraging news overall. Your mom is showing significant signs of improvement, and these are exactly the milestones we want to see when someone is coming off sedation in intensive care.

So, how long does it take for the throat to heal after intubation and ventilation?

Let me answer your question about throat healing. When someone has an endotracheal tube or a breathing tube in their throat, it causes a lot of irritation, inflammation, and sometimes minor trauma to the vocal cords and throat tissues. So, timelines you can typically expect is that the throat usually takes 3 to 7 days to heal enough for comfortable speaking after the breathing tube is removed, which is also known as extubation. However, this varies significantly based, based on how long your mother was intubated. Whether she had any complications like a difficult intubation, her overall health status, whether she develops any throat swelling or vocal cord damage.

Now here’s what’s really important right now with the breathing tube still in place. Your mother cannot speak at all because the endotracheal tube passes directly through the vocal cords, making it physically impossible to produce sound. This is completely normal and expected, and if I was you, I would not ask her to say anything at all, because it’ll only cause frustration for you and for her because you won’t be able to understand her. It’s very difficult for her to mouth a word or any words with a breathing tube in the mouth.

I would focus on giving her a pen and a piece of paper and write down things. Please do not ask her to speak with a breathing tube, it’ll only cause confusion, potentially aggression and frustration on all ends. I hope that makes sense.

So, what are the first words to try when ICU patients wake up? Like, I need to manage your expectations here. While your mother cannot speak with a breathing tube in place, you can still communicate. Here’s what works best. Simply ask yes or no questions; ask her to squeeze your hand once for yes, twice for no; thumbs up, thumbs down; pointing to pictures or words; a communication board with the alphabet; writing if her hand strength allows and I would not go to mouthing words because it’s so difficult and it’s just causing frustration. Trying liberating can be very frustrating with a breathing tube in the mouth.

First words to try after the breathing tube comes out. Once the ICU team removes the breathing tube, and only when they determine she’s ready, start with just simple hi or hey, yes and no. The most practical first words – her own name, or your name, water, often one of the first things patients want, pain, important for medical management. Ask the ICU team if she can have some ice chips. A lot of patients after extubation want either water or they want ice chips. Ice chips are safer because it’s less risk of aspiration.

Unlike babies learning to speak for the first time, adults who are recovering from critical illness and intubation already have the neurological pathways for speech. They just need their throat to heal and their strength to return. Your mother’s voice will most likely be hoarse or raspy, potentially weak initially, potentially painful to use in the first few days, and it’ll improve gradually over days to weeks, give it some time.

But let’s look at the positive signs you’re seeing right now. Let me highlight what’s really encouraging about what you’ve described.

Number 1. She’s off sedation and opiates, that’s Number 1. This is huge. Her brain is no longer suppressed by medications.

Number 2. She’s opening eyes spontaneously and closing them herself shows there’s neurological function.

Number 3. There’s purposeful movement. Reaching for the tube and scratching her head are intentional actions.

Number 4. She’s following you with her eyes. This is called tracking and shows cognitive awareness.

Number 5. She’s moving her legs. It demonstrates she’s not paralyzed and has motor function.

Number 6. She’s more awake. Progressive improvement in consciousness.

These are all fantastic signs that your mother’s brain is recovering.

Next, let’s talk about the importance of having access to all medical records, again.

Angela, as we move forward with your mother’s care, it is absolutely critical that you have access to all of her medical records, and here’s why. Complete medical history helps us understand complications. Daily progress notes show trends in her recovery, ventilation settings tell us how close she is to breathing independently, lab results and vital signs reveal her overall organ function, imaging reports such as chest X-rays, CT scans show lung condition. Medication lists help us identify potential issues. Because without complete medical records, we’re making decisions with incomplete information, and that is simply dangerous in ICU.

Have a consulting call with myself or someone from our team will help. It’s exactly where a consulting call with myself or the team at intensivecarehotline.com becomes invaluable because here’s what we do. We join you on a call with the ICU team to question the medical team about your mother’s treatment plan, advocate for your mother’s best care and treatment, clarify confusing medical terminology and explanations, challenge decisions that don’t seem in her best interest. Ensure all options are being considered, including weaning protocols, get clear answers about timelines and prognosis, push for appropriate testing and monitoring such as chest x-rays, arterial blood gases, spontaneous breathing trials, and so forth.

Many families in in in intensive care tell us that having an ICU expert on their side and on their team completely changes the dynamics with the medical team. Doctors respond differently when they know they’re being held accountable by someone who understands intensive care medicine inside out.

We can help you ask the right questions right now. What are the criteria for extubation, which is removing the breathing tube? What’s the weaning plan from the ventilator? Has she spawned? Has she passed spontaneous breathing trials? What’s the plan if she can’t be weaned off the ventilator? Are there any complications preventing extubation? And let’s also look at what if your mom can’t be weaned off the ventilator?

Angela, I know this is difficult to think about, but we need to prepare for all possibilities.
Some patients require long-term ventilation, and if your mother can’t be weaned off the ventilator, she may need a tracheostomy, or it’s the first step, she may need BIPAP (Bilevel Positive Airway Pressure)/CPAP (Continuous Positive Airway Pressure) ventilation. If she’s extubated, maybe she can continue with BiPAP/CPAP after extubation, but if that fails, she needs to be reintubated and then she might need a tracheostomy.

This is where intensivecareathome.com becomes your long-term solution. If your mother needs ongoing ventilation and tracheostomy care, intensivecareathome.com can help you. Keep your mother out of ICU predictably and permanently. Provide ventilator care at home, with or without a tracheostomy, but also tracheostomy care without a ventilator.

So, all situations are covered with intensivecareathome.com. If your mom does need a tracheostomy, we ensure that tracheostomy management is performed by trained professionals, 24 hours a day, i.e. with critical care trained nurses. Which is why we are intensivecareathome.com.

It gives her a better quality of life outside of the hospital, it reduces complications associated with prolonged ICU stays, saves significant costs compared to long-term ICU.

Many families don’t realize that home ventilation is possible, home tracheostomy care is possible, and often preferable to keeping someone in institutional care long-term.
With the right team and equipment, patients can live comfortably at home even with complex medical needs.

Next steps for Angela’s mother.

Here’s what I recommend you focus on right now. Immediate priorities. Request a family meeting with the ICU team to discuss the extubation plan; Obtain all medical records, you have a legal right to these; continue your daily video calls, your presence is therapeutic; document everything, keep notes on her progress and what staff tell you; ask about speech therapy evaluation, they should be involved post extubation; and of course, get me on another consulting call with you because you’re not getting the answers from the ICU team.

They’re probably only telling you half of what’s going on because you don’t have access to the medical records yet, because the timeline for extubation keeps getting pushed back, making it more likely that your mom ends up with a ventilator associated pneumonia and needs a tracheostomy and then you’re being told she needs a tracheostomy. And you also feel the medical team isn’t being aggressive enough with weaning. You absolutely need someone to advocate during this time because this really matters for your mom’s recovery.

Because your mom is at a critical juncture, the decisions made in the next few days and weeks will significantly impact her long-term outcome. This is not the time to be passive or assume the medical team is considering every option. Having an advocate who understands ICU care can speed up recovery by ensuring aggressive weaning protocols and ICU teams are held accountable. Prevent unnecessary procedures like tracheostomy if avoidable. Identify complications early before they become serious. Ensure optimal care even in understaffed units and get your mother home faster and save her with or without intensivecareathome.com.

Get help now, don’t wait until it’s too late. If you need help navigating your mother’s care, and you clearly do, do not wait. Every day in intensive care increases the risk of complications. Contact us at intensivecarehotline.com now on one of the numbers on the top of our website or send us an email to support at intensivecarehotline.com.

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 for our clients in intensive care. You can verify that on our intensivecarehotline.com testimonial section and also on our intensivecarehotline.com podcast section where we have done client interviews.

Because our advice is absolutely life changing, it is absolutely life changing. That’s why you can join a growing number of members and clients that we’re helping in intensive care. We’re improving their lives instantly, making sure families in intensive care can make informed decisions, have peace of mind, control, power and influence, making sure their loved ones get best care and treatment always.

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 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. That is exactly what you’re up against.

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. When I talk to doctors and nurses directly, which I do as well, you would see the dynamics change in your favor very quickly because you have someone on your team that understands intensive care inside out.

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 eBooks and 21 videos that I have personally written and recorded that only our members have access to.

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.

Take care for now.