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Quick Tip for Families in Intensive Care: My Husband Gets Agitated with High Blood Pressure When Waking Him Up on the Ventilator in ICU! Help!

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

So, today’s tip is a question that I’m answering from Miriam who says,

“Hi Patrik,

 My husband is in ICU and then not giving him something for his high blood pressure. When the sedation wears off and he answers me everything, but his blood pressure is at a stroke level. So, they’re trying to put him back out again and he doesn’t get to do the breathing trial really because they’re not giving him anything to relax him and his anxiety. So, they are sedating him immediately again.

He’s been on a ventilator for two weeks and they are trying to tell me I have to make a decision about a thing to even do a tracheostomy by tomorrow. So, I believe they have done something wrong. Something is not right, but I think they can give him something for his blood pressure.”

Miriam, that’s not an uncommon situation that you are describing. I’ve seen it many times when you’re trying to wake people up from sedation and from opiates and you’re trying to wean them off the ventilator with the breathing tube, you absolutely have to do the right thing, but it really depends.

When his blood pressure is going up to stroke levels, what you’re mentioning, could be like probably 150 systolic and above, yes, they should absolutely give him some blood pressure medication to get his blood pressure down, (A) so he’s not sustaining a stroke, of course, that would be very detrimental to his recovery, and (B) the other question is, is he potentially breathing against the ventilator?

So, let’s just say they’re trying to keep him awake and they are giving him something for his blood pressure. If he’s breathing against the ventilator or if they can’t lower the support, they’re giving him from the ventilator, that could be another issue that pushes him towards the tracheostomy so that he can’t be off the ventilator.

So, things to look for, for example, would be, what is his PEEP (Positive End-Expiratory Pressure) like? What is his pressure support like? What ventilation setting is he on, for example? Is he in a controlled mode, i.e., the support is predominantly coming from the ventilator, or is he breathing on CPAP (Continuous Positive Airway Pressure) or pressure support? Is he passing spontaneous breathing trials?

Now, I do understand from your email that he hasn’t passed spontaneous breathing trials even though he’s awake and his blood pressure is high. So, that could simply mean that he’s not ready for a spontaneous breathing trial and that he simply needs more support to get him stronger to let his lungs rest and heal.

You haven’t shared why your husband is in ICU. Does he have a pneumonia? If you have a stroke, is there something else? Does he have ARDS (acute respiratory distress syndrome)? If you have surgery, you didn’t share any of that, but it is often, or it can be touch and go. When you’re trying to wake someone up, you wake them up and they are not cooperative, they’re agitated, they’re thrashing around, they seem to be confused and that’s a very unfortunate situation.

It’s very hard to watch for doctors and nurses, but of course, especially for families. It’s very hard to watch when their loved one is not cooperating. They might be confused because they’re coming out of an induced coma.  It can be a very tricky situation.

But other things that you could look for, are they trying to help him talk through the situation? A lot of it comes down to doctors and nurses being calm and reassuring and talking your husband through what’s happening and how he should breathe. That can help as well, calming him down. So, I’m not sure whether that is happening here or not, but this is certainly something you should be looking for that he has calming people around him.

If all of that fails, then after two weeks in ICU, he should have a tracheostomy if he can’t come off the ventilator. Here is the advantage of a tracheostomy, sedatives and opiates should come off immediately.

One of the reasons you sedate a patient on a ventilator with a breathing tube and you give them opiates is simply, it’s very uncomfortable, that’s why they need to be sedated. You do a tracheostomy most of the time you just stop sedation and opiates altogether. Then, it’s easier for him to wake up and wean off the ventilator, hopefully immediately. It’s also easier to mobilize him, to get him stronger, sit him out of bed, all of that.

Also, the other thing why his blood pressure might go up, the breathing tube might be very uncomfortable and that’s why his blood pressure goes up. He might be in pain, and you got to give him pain medications. It’s sort of a vicious cycle.

Whereas him having a tracheostomy might speed up getting him off the ventilator. Yes, it is surgery. I wouldn’t give consent to a PEG (Percutaneous Endoscopic Gastrostomy) tube because the tracheostomy here should be temporary, no need for a PEG tube. Get him off the ventilator and then hopefully have the tracheostomy removed as well within a few weeks.

If worse comes to worse, God forbid, he can’t be weaned off the ventilator, can’t be weaned off the tracheostomy, you should be looking at intensivecareathome.com for home care options.

So, that is my quick tip for today.

Another thing that you may want to consider, do they need to change sedatives? Do they need to change him from midazolam/Versed to Precedex? Do they need to change him from propofol to Precedex? Do they need to change him from morphine to fentanyl? Things like that, you have to ask.

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 that is exactly what you are dealing with here.

So, I’ve worked in intensive care/critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years in intensive care. I have been consulting and advocating for families in intensive care since 2013.

You can look up our testimonial section, our podcast section with some client interviews. I can say without the slightest hint of exaggeration that we have saved lives with our consulting and advocacy, and we can do the same for you. We have saved patients from needing a tracheostomy because we can hold intensive care teams accountable, making sure they’re doing all the right things, and we can do the same for you.

That’s why we created a membership for families of critically ill patients in intensive care at intensivecarehotline.com. You can click on the membership link there and become a member there or you can 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.

If you are a member, you also have access to 21 e-books and 21 videos that are specifically written and recorded just for our members that really help you to make informed decisions, have peace of mind, control, power, and influence.

I also offer one-on-one consulting and advocacy for families in intensive care over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I also talk to you and your families directly as part of the one-to-one consulting advocacy. But more importantly, I also talk to doctors and nurses directly with you. I will ask the questions that you haven’t even considered asking but must be asked when you have a loved one in intensive care, again, 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 have 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.

Lastly, I also represent you in family meetings with intensive care teams, once again, so that you have an advocate there and someone that understands intensive care inside out. I have been in hundreds of family meetings with intensive care teams, either when I was working in ICU or here at intensivecarehotline.com and talking to so many intensive care teams all around the world once again with great outcomes that you can see on our testimonial section and our podcast section.

Now, all of that you get at intensivecarehotline.com. You can click you can call us on one of the numbers on the top of our website or simply send us an email to [email protected].

If you like my videos, subscribe to my YouTube channel channel for regular updates for families of critically ill patients 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 and what questions and insights you have from this video.

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.