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.

And if you like this video, make sure you subscribe to my YouTube channel. Click the like button, click the notification bell, and share this video with your friends and families who need to hear this.

So, in today’s video, I want to answer a question from one of our clients, Christopher, who says,

“Hi Patrik, 

I believe they’re doing a CT (Computed Tomography) scan with contrast of my wife’s brain. The concern is her weakness when following commands. The doctor mentioned vasculitis as a result of meningitis. She’s off sedation now, but they put her back on Precedex when she became anxious and tried to breathe over the ventilator. She had Propofol and fentanyl over the weekend and was out of it all weekend. Do you think it’s right to put her on sedation every now and then? Should she have a tracheostomy to wean her off the ventilator, stop using sedation so she can get mobilized and start physiotherapy, or is it too early for all of this?”

It’s a great question, Christopher, and I get it all the time from families in intensive care. So, let’s talk about sedation and its impact first.

When your loved one is ventilated, doctors and nurses in ICU often use sedation, medications like Propofol, fentanyl, Precedex, which is also known as dexmedetomidine, or midazolam, also known as Versed, to help them tolerate the breathing tube and the ventilator. But here’s what many families are not told, the longer sedation continues, the harder it becomes to wake up and start breathing independently. Sedation suppresses the brain, weakens muscles and slows recovery. It can mask neurological progress, making it difficult to know if weakness is from sedation or the underlying illness.

So, if the sedation keeps getting turned back on every now and then, it’s time to ask the ICU team, what’s the plan to stop sedation and opiates completely? Is my loved one really not ready to breathe over the ventilator or is it simply that sedation is being used for too long? Also, sedation and opiates in the ICU are also known to cause ICU psychosis and ICU delirium if overused. The goal is always to, in the beginning, minimize sedation, opiates, and wean them off as quickly as possible. The longer your loved one stays in an induced coma, the more likely it is they’re not going to wake up, and waking up is going to be delayed. They lose muscle tone, they deteriorate, they get deconditioned, and that all comes with a delay in recovery.

Now there are situations where sedation and opiates must be used, when patients are having head injuries, brain injuries, traumatic brain injuries in particular, but again, even then the goal is to wean it off as quickly as possible, so you can also establish a baseline, what your loved one is capable of doing after the critical illness.

Next, when to consider a tracheostomy. Now, about the tracheostomy, if your loved one has been ventilated for more than 10 to 14 days with a breathing tube and weaning attempts are failing or have failed, or sedation and opiates can’t be stopped safely, a tracheostomy should be considered.

Here’s why. It allows for minimal or no sedation, it’s more comfortable than an endotracheal tube, it helps with weaning, physiotherapy and early mobilization. It enables better communication, faster recovery, and also a transition home if possible.

Some ICUs delay tracheostomies, keeping patients sedated for weeks, which can lead to ICU-acquired weakness, delirium, and prolonged dependence on the ventilator, as just discussed. A tracheostomy can change that dynamic completely. It allows the patient to wake up, regain strength, start physiotherapy sooner, all key steps forward of getting out of ICU.

And it’s also a vehicle that if your loved one, God forbid, cannot be weaned off the ventilator or the tracheostomy, it’s a vehicle to go home with Intensive Care at Home where we bring the ICU into the home, and you can find more information at intensivecareathome.com.

Next, vasculitis, meningitis and weakness. Now you mentioned vasculitis from meningitis. That’s a possible cause of neurological weakness, and the CT brain with contrast will help rule that out. However, sedation itself, especially when used repeatedly, can cause similar symptoms like weakness, delayed responsiveness, and inability to follow commands.

So it’s now a question of, is your wife not waking up because she continues to have a brain injury, or is she not waking up because she’s too sedated? Her body is full of opiates and sedatives. So before concluding that neurological issues are permanent, it’s vital to minimize, even stop sedation and opiates and reassess the patient’s responsiveness after 24 to 48 hours.

Also, your wife is breathing above the ventilator. Now that can be a good sign, it depends on how she’s breathing above the ventilator. Is it controlled? Is it rapid? Is she breathing against the ventilator? Are the volumes high enough? Are they matching her body weight, her body index? Literature suggests 7 to 10 mLs per kilogram per breath, right?

So it might be a good thing, as long as it’s controlled, adequate in ventilation, and arterial blood gases are looking good, maybe when sedation is stopped, she can completely breathe independently.

The biggest challenge for families in intensive care is 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.

So, what are the next steps, Christopher, and what are the alternative care options?  If your wife remains weak, ventilator dependent, and ICU care seems never-ending, and she does need a tracheostomy, the best next option is Intensive Care at Home, and you can find more information at intensivecareathome.com, where we provide a real alternative to long-term ICU stays. We look after ventilated and tracheostomy adults and children at home with 24/7 intensive care nurses, giving our clients quality of life and families peace of mind outside of ICU. And if you’re in ICU watching this, we’re freeing up your ICU bed, and cutting the cost of the ICU bed by around 50 percent, that’s 50.

So once your loved one or your wife is more stable, you can safely transition from ICU to home safely, professionally, and with full medical support. If you want to discuss your loved one’s situation in detail, go to intensivecarehotline.com and book a free initial confidential consultation with me, right now.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over five 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 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, right? 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 handhold 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, so, 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 the best care and treatment always.

And all of that you get at intensivecarehotline.com. Call us on one of the numbers at the top of our website or simply send us an email to support at intensivecarehotline.com with your questions.

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.

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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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