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, making sure your loved one always gets best care and treatment, even if you’re not a doctor or a nurse in intensive care.

Now today I have a question from one of our clients, Janine, who says,

“Hi Patrik,

My mother is still on the ventilator in ICU and I’ve sent you a picture, that I attached, she was placed on SIMV twice during the middle of the night and today for a while. She will be placed below on pressure support. Is this normal? I hope we don’t have to start all over again. She’s still getting the ciprofloxacin. Thank you for all your help.

From Janine”.

Now thank you Janine, for your question and for sharing that picture of your mother’s ventilator as well. I can absolutely understand your concern about seeing these mode changes on the ventilator, especially when you’re watching your mother go through this very difficult time in ICU.

So, to come to your question right away, is switching between SIMV and pressure support normal? And let me reassure you right away, yes, it is absolutely normal, what you’re seeing with your mother being placed on SIMV, which stands for synchronized intermittent mandatory ventilation, and then transitioning to pressure support is actually a very positive sign, and here’s why.

When someone is being weaned off a ventilator in ICU and the breathing tube, the ICU team doesn’t just flip a switch and take them off the ventilator and off life support. It’s a gradual step by step process that involves.

1.  Reducing sedation and opiates so your mother can breathe more and more on her own so that she can wake up more and more.

2.  Testing her breathing strength with different ventilation modes and

3.  Gradually reducing support as she demonstrates she can handle more of the breathing work herself.

So, let’s look at what SIMV and pressure support actually means. So SIMV, which again stands for Synchronized Intermittent Mandatory Ventilation, provides a set number of guaranteed breaths from the ventilator per minute. It also provides support for any additional breaths your mother takes on her own. It’s basically a safety net while it’s still allowing spontaneous breathing.

Pressure support is actually a less supportive mode. Which means your mother is doing more of the breathing work herself. The ventilators only assisting her breaths, not taking over. This is typically the final step before coming off the ventilator completely.

So why this back and forth? The ICU team is likely doing what’s called weaning trials, they’re testing your mother’s ability to breathe with less support. If she tolerates pressure support well, that’s excellent news and excellent progress. If she gets tired or her numbers aren’t quite where they need to be, they may put her back on SIMV temporarily to give her a rest. This is completely standard practice and doesn’t mean you’re starting over again.

Think of it like physical therapy, you don’t run a marathon on day one, you build strength gradually and sometimes you need rest day.

So, Janine, I want to emphasize something crucial here, and that’s the critical importance of having access to all medical records. Well, I can give you general guidance based on the information you’ve shared, including the picture of the ventilator of your mom, having access to all of your mother’s medical records is absolutely essential for understanding her complete situation.

Here’s what you need. Complete ventilation settings and trends, not just a snapshot, because what you’ve sent me, she’s in pressure support, but she might be in pressure support for 10 minutes and then goes back into SIMV, so the devil is in the detail.

In order to complete the picture when it comes to ventilation weaning, we also need to see chest X-rays and imaging reports. And very important, we also need to look at arterial blood gas results, also known as ABGs, showing oxygen and carbon dioxide levels.

Also, we need to see other lab results, pathology results, including white cells count, kidney function, liver function, etc., culture results are especially important since you mentioned she’s on ciprofloxacin, daily progress notes from the ICU team, sedation and opiate records and medications, medication lists.

Again, I can’t just look at the one snapshot of a ventilator and give you all the ins and outs in terms of where your mom is at in terms of ventilation weaning. It gives me an idea, but it’s a very incomplete picture. And this is exactly where a consulting call with myself or with someone from our intensivecarehotline.com team becomes invaluable.

Here’s what we do for you. Expert analysis and advocacy. During a consulting call, we will review the medical records in detail with you, explain what each test result and ventilation setting means in plain English. Identify the specific questions you need to ask the ICU team. Help you understand the prognosis and realistic timelines. Advocate for your mother by helping you communicate effectively with the ICU team. And question treatment decisions when necessary and appropriate.

I basically ask questions that you haven’t even considered asking, but must be asked when you have a loved one critically ill in intensive care. And one of the most powerful tools of my service I offer is joining you on calls with the ICU doctors and specialists. We can ask the tough questions you might not know to ask, challenge assumptions if something doesn’t add up, ensure you’re getting complete answers rather than vague reassurances, push for clarity on the weaning plan and timeline, advocate for aggressive treatment or alternative approaches when appropriate.

You don’t have to navigate this alone, and you don’t have to simply accept what you’re told without understanding fully.

Now, based on what you’ve shared. Here are some critical questions you should be asking the ICU team.

Number 1. What are the specific parameters you’re looking for before moving her to pressure support permanently? What is the planned weaning protocol? How long on each mode, what triggers changes, what are her blood gas results, PaO2 (partial pressure of oxygen), PaCO2 (partial pressure of carbon dioxide), pH levels.

Why is she’s still on ciprofloxacin, what infection are they actually treating and what were the culture results? What is her respiratory rate, tidal volume, and rapid shallow breathing index? Are there any complications preventing faster weaning? What is the timeline for potential extubation, removing the breathing tube? How much FIO2 (fraction of inspired oxygen) is she on, and what is her PEEP (Positive end-expiratory pressure) and pressure support?

Janine, I know this may be difficult to think about right now, but it’s important to be prepared for all possibilities. Some patients who have prolonged ventilation or underlying lung conditions may need long-term ventilation support, and if the ICU team starts talking about a tracheostomy, which is a surgical opening in the neck for long-term ventilation, or if your mother has difficulty weaning, I want you to know about an incredible alternative, and this alternative is Intensive Care at Home and you can find more information at intensivecareathome.com because with intensivecareathome.com, we can keep your mother out of ICU predictably and permanently.

Intensive Care at Home offers a revolutionary, predictable, and genuine alternative and option that allows patients who need long-term ventilation with tracheostomy to leave the ICU and live at home with proper ventilator support, with 24-hour intensive care nurses. Avoid repeated ICU admissions that are traumatic and expensive, maintain quality of life in familiar, comfortable surroundings. Receive expert care with 24-hour intensive care nurses, with proper support for patients and families. Have 24-hour critical care nursing care at home from experienced professionals who understand ventilation and tracheostomy care, this isn’t just a pipe dream. This is a proven successful model that has helped countless families keeping their loved ones out of ICU predictably and permanently, even when they require ongoing ventilation or have a tracheostomy.

Many patients who are told they can only stay in ICU long-term with a ventilator or a tracheostomy or that ICU wanted to stop life support and basically let those patients die because they wouldn’t have any perceived, “quality of life”, now live a quality of life that is good for them and their families in a nice and holistic home care environment because at home, patients and families can actually thrive with the right support system, which is 24-hour intensive care nurses.

Also, Intensive Care at Home reduces the risk of hospital acquired infections, provides a much better quality of life, keeps families together, and costs around 50% of a $6000 per bed day intensive care bed. And most of all, it gives patients and families dignity, respect, and comfort.

So, Janine, to directly answer your worry, no, you are not starting all over again. What you’re seeing is the normal ebb and flow of weaning from mechanical ventilation with a breathing tube. The fact that they’re attempting pressure support at all is a positive sign that your mom has enough respiratory strength to be in the weaning process in the first place.

Some patients take days, others take weeks, others take weeks and sometimes even months, especially with a tracheostomy, but every patient is different.

The key factors are. Treating any underlying infections, hence why she’s on the ciprofloxacin, ensuring adequate nutrition and strength, managing any other organ system issues, gradually building respiratory muscle endurance, finding the right balance of support.

Take action now.

Janine, I know how stressful and overwhelming this is. You’re watching every number on that monitor, analyzing every change and worrying about what it all means, that’s completely natural, but you certainly don’t have to do any of this alone.

Because once you’ve got access to the medical records and you document every conversation with doctors and nurses, take photos of the ventilator settings throughout the day like you did, keep a journal of what you observe and questions you have, and call me at intensivecarehotline.com to schedule a consulting call.

Don’t wait until things get more complicated or until you feel completely ready or lost. The earlier you get expert guidance, the better outcomes tend to be.

Go to intensivecarehotline.com, call us on one of the numbers on the top of our website or send us an email to [email protected]. 

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 because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.

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’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why 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 simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking 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 in case 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, and you can become a member if you go to intensivecarehotline.com, if you 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. All of that will help you to improve your life instantly, 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.

Take care for now.