My name is Patrik Hutzel from intensivecarehotline.com, where we instantly improve the lives of 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.

First off, I have a question today from Mellie, who is one of our clients who says,

“Hi Patrik,

Thank you so much for talking to the nurse and the doctor. After the call, I stepped in to see my grandmother, who was opening her eyes and she even moved her legs a bit, even though she had a stroke. They went in to suction her, and you can tell that it causes a lot of discomfort for her because she opens her mouth and tries to move a little bit. The ICU nurse who did the suctioning said that’s the most awake he has seen my grandma, and that she had a run of spontaneous breathing trials with the breathing tube and that she did really well. It’s just that she can’t protect her own airway. What therapies, exercises, and measures do you think will help?

I also want to thank you, Patrik, and your amazing team for all the support and help that you have offered to me and my family. I truly have no idea what we would do without you all. Finding intensivecarehotline.com has been such a blessing for us. Since my grandmother was admitted into the hospital 6 weeks ago, I have learned so much. You and your team have given me the strength to continue fighting and standing my ground to be the best advocate for my grandma. It is such a safe place for so many families, and I’m so happy to know there are genuinely good people out there trying to help. We are so grateful to you all.”

From Mellie.

Well, thank you, Mellie, for your kind words.

I also want to remind you that everything in this article and video represents my own opinion based on my 25 years of experience working in intensive care and critical care. It is not medical advice and you should always consult with your own healthcare team about your specific situation.

Mellie, first of all, thank you so much for your kind words and for trusting us to help you advocate for your grandma. It’s families like yours that remind us why we do this work every single day at intensivecarehotline.com. You have been an incredible advocate and your grandmother is lucky to have you fighting for her.

Let me break down to you what’s happening with your grandmother. The ICU nurse mentioned she did really well on a spontaneous breathing trial, which is actually fantastic news. This means her lungs and breathing muscles are strong enough to breathe without the ventilator or minimal support from the ventilator, and she’s doing most of the work for her breathing. However, the challenge here is airway protection. After a stroke, many patients struggle with what we call their protective reflexes, the automatic responses that keep food, saliva, and secretions out of the lungs. This is why she needs frequent suctioning, which you’ve noticed, and it’s causing her discomfort.

Therapies and exercises that can help: Here are the key interventions that typically help patients regain airway protection after a stroke.

1. Speech and language pathology assessments. This is absolutely critical. A speech pathologist doesn’t just work on talking, they’re experts in swallowing and airway protection. They can perform a swallow study to assess exactly what’s happening and create a targeted therapy plan.
2. Neuromuscular electrical stimulation. This therapy uses electrical stimulation to strengthen the muscles involved in swallowing and airway protection. It’s shown good results in stroke patients.
3. Head and neck positioning. Proper positioning can significantly improve airway protection. The ICU team should be working with physical therapy to find the optimal positioning for your grandma.
4. Progressive oral motor exercises. Once she’s more alert, specific exercises for the tongue, lips, and throat muscles can help rebuild coordination and strength.
5. Gradual mobilization. Getting patients out of bed and sitting upright can and will dramatically improve airway protection and reduce secretions. If she’s opening her eyes and moving her legs, this is a perfect time to push for more mobility.
6. Coughing exercises once the breathing tube is out, because part of airway protection is coughing, right? Coughing exercises is also going to be very important.

Next, Mellie, one thing that’s absolutely crucial right now is making sure you have access to all of your grandma’s medical records. You need the complete picture. Everything: her CT scans, MRI results, neurology notes, respiratory therapy assessments, daily progress notes from doctors and nurses, fluid balance charts, ventilation charts, vital observation signs, and so forth. We have a full list of what needs to be in medical records because what we’re finding over and over again is that hospitals do not give you full access to medical records. They’re shortchanging you for a number of reasons that I’m not going to detail now, but the bottom line is you need to get access to all medical records and you have a right to access medical records. You have a right, it is not a privilege.

These records will show us exactly where the stroke occurred, what deficits are expected, and what the trajectory for your grandma looks like, and also if the ICU team is doing all the right things. You better follow up on that because here at intensivecarehotline.com, we can review these records with you during a consulting call and help you understand what questions to ask and what to advocate for with the ICU team, or we review them and send you a report, a summary.

A consulting call with myself or one of my team members can make all the difference right now. We can join you on calls with the ICU team to help clarify medical information, question treatment decisions, and advocate for the therapies your grandma actually needs. Many families tell us they feel so much more confident when they have an experienced ICU nurse or specialist backing them up in a call with ICU teams because we will help you to ask the right questions about the specific stroke location and expected recovery timeline, whether a tracheostomy might actually be beneficial at this stage, what rehabilitation potential exists, whether the current ICU is providing adequate stroke and respiratory rehabilitation, and what the roadmap looks like for getting her off the ventilator.

Mellie, I also want you to know about Intensive Care at Home, and you can find more information at intensivecareathome.com because this is a genuine long-term option. If your grandma needs prolonged ventilation and possibly a tracheostomy, this doesn’t mean she has to stay in ICU indefinitely or move to a long-term facility which can’t look after her anyway. Because with intensivecareathome.com, we can help you keep your grandma out of ICU predictably and permanently if she requires long-term ventilation and/or a tracheostomy. Whether she needs ventilation with a tracheostomy, whether she needs ventilation, BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure) without a tracheostomy, or whether she needs a tracheostomy without ventilation, we can help you with Intensive Care at Home, getting your grandma home. Because many stroke patients recover much better in a home care environment surrounded by family, with one-on-one critical care nurses instead of the chaotic and non-patient-friendly ICU environment. This option also includes end-of-life care if that becomes the appropriate path, but let’s focus on recovery right now because the signs you’re describing are actually quite encouraging.

The encouraging signs are: she’s opening her eyes, this shows improving neurological function. She’s moving her legs despite the stroke, this is excellent. She passed the spontaneous breathing trial, her respiratory muscles are working. She’s responding to uncomfortable stimuli, the suctioning, and this shows awareness. These are all signs that with the right therapies and aggressive rehabilitation, there’s real potential for recovery.

What are the next steps for your grandma? Here’s what I’d be advocating for if this was my family member. Immediate speech pathology consultation with a bedside swallow evaluation or modified barium swallow study. Daily assessment of neurological improvement, is she getting stronger every day? Aggressive mobilization protocol, getting her sitting up, potentially to a chair, doing physical therapy, legs, arms, and so forth. Consider a tracheostomy if prolonged ventilation is expected. This often allows better rehabilitation and is more comfortable than an endotracheal tube. And the reason I want to point this out here as well, Mellie, I know your grandma has been in ICU now for 6 weeks, and she’s been ventilated with a breathing tube for 6 weeks. If she cannot be extubated in the next couple of days, she will need a tracheostomy.

Next, neurological involvement to assess stroke recovery potential and expected timelines. Discussion about rehabilitation facility transfer for neurological rehabilitation in particular, once she’s stable enough, but they need to be able to provide ventilator and tracheostomy care if that’s where it’s getting, and a lot of rehabilitation facilities can’t do that. This is again where Intensive Care at Home comes in, and you want to check out intensivecareathome.com.

But the good news is, Mellie, you’re not alone in this fight. You’ve already proven yourself to be an incredible advocate. 6 weeks is a long time, and I know you’re exhausted, but your grandma is showing signs of improvement, and that’s what matters. Finding intensivecarehotline.com isn’t just luck, it’s you being proactive and refusing to accept uncertainty. That’s exactly the kind of advocate every ICU patient needs.

If you need help navigating this situation, please don’t hesitate. Call us directly at intensivecarehotline.com to discuss your grandmother’s case. Email us to [email protected] with medical records so we can provide specific guidance. Schedule a consulting call where we can join discussions with the ICU team. Explore intensivecareathome.com options if long-term ventilation plus or minus tracheostomy becomes necessary.

Remember, having an experienced ICU professional review the records and advocate alongside you will completely change the trajectory of your grandma’s care. Your grandma is blessed to have you fighting for her. Keep asking questions, keep advocating, and know that we’re here to support you every step of the way. Stay strong and please keep us updated about your grandma’s progress.

I have worked in critical care nursing for 25 years in 3 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. And I can very, very, very confidently say that we have saved many lives with our consulting and advocacy because of our insights, and you can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we have done client interviews. And 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. And 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 the best care and treatment always. And 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.

And that’s why I do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. And I talk to you and your families directly. I hand-hold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. And 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 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 e-books and 21 videos that I’ve personally written and recorded, and 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. And 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. And 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, what questions and insights you have from this video.

I also do a weekly YouTube live where I answer your questions live on a show and you will get notification from the YouTube live if you are a subscriber to my YouTube channel or if you are a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com.

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.

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