Hi there!
Today’s article is about, “Quick Tip for Families
in Intensive Care: Mom’s Been on Ventilation 21 Days, Lowest Settings & We’re Pressured for a Tracheostomy as Only Option!”
You may also watch this through this YouTube link https://youtu.be/XxoJeUOJAYY or you can continue reading
the article below.
Quick Tip for Families in Intensive Care: Mom’s Been on Ventilation 21 Days, Lowest Settings & We’re Pressured for
a Tracheostomy as Only Option!
Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So, today’s tip is a question from Tracy who asks, “My mom has been in ICU, has
been on the ventilator with a breathing tube on the lowest setting for 21 days now, and we are being pressured to put in a tracheostomy with no other options. From, Tracy.”
Okay, Tracy, great question. Well, again, it keeps coming back to what I’ve been saying over and over again, that 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, typically
here.
Now, if your mom is on the lowest settings on the ventilator, let’s just quickly break that down what that actually means. So, she’s on the lowest settings on the ventilator, which means she would be breathing on CPAP (continuous positive airway pressure) on pressure support, with a PEEP (positive end expiratory pressure) of 5, with a pressure support of 8 or less, with FiO2 oxygen on the
ventilator less than 40%, ideally less than 35%.
Her tidal volumes would need to be adequate according to her weight, which means breathing 7 to 10 mls per kilo. So that means for simplicity, if your mother is 70 kilos, she breathes 7 to 10 mls per kilo, she would be breathing around between 490 and 700 mls per breath.
Furthermore, if her respiratory rate, her breathing rate is between, let’s just say 8 and 25, if she’s awake, if she’s obeying commands, if her arterial blood gases are fine, she has a good strong cough, then, there is absolutely
nothing that should stop them from taking out the breathing tube and extubate your mom.
Now, if any of the things that I just explained are off, that might be an obstacle for your mom to have the breathing tube removed and get
extubated. Keep that in mind. I have written an article, “How to wean a critically ill patient off the ventilator and the breathing tube?” I encourage you to check out
that video or blog post because it walks you through step-by-step when to extubate someone.
Now, the other thing that you haven’t mentioned is, is your mom still sedated or on opiates? Or if she is,
then they need to switch that off. Here is another question, let’s just say your mom, God forbid, has a neurological condition such as a stroke, a hypoxic brain injury, an anoxic brain injury, and a traumatic brain injury, some seizures, she might not be able to protect her airways,
she might not cough, she might not be able to swallow, which is why she might need a tracheostomy.
Again, it comes back to that the biggest challenge for families in intensive care is that they don’t know what they don’t know.
Next, if your mom has been on the ventilator for 21 days, the cut off usually
to do a tracheostomy is around Day 10 to Day 14. So, why has it been 21 days? But the quickest way for us to find out what is actually really going on is by me talking to the doctors and nurses directly, by setting you up with more questions to ask, or by looking at the medical records.
Ideally, we do a combination of all of that.
That’s also one of the reasons why we created a membership for families of critically ill patients in intensive care at intensivecarehotline.com if you click on the membership link there or if you go to intensivecaresupport.org directly. You can get access to our membership where 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.
I have worked in critical care and intensive care
for over 20 years in three different countries where I also worked as a nurse manager for over 5 years, and I’ve been consulting and advocating for families in intensive care all over the world for the last 10 years as part of my intensivecarehotline.com consulting and advocacy service. Look up our testimonial
section and look up our podcast section with client interviews. I can confidently and without any exaggeration say that we have saved lives with our consulting and advocacy.
I also offer one-on-one consulting and advocacy over the phone via Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly and I talked to doctors and nurses directly and I ask all the questions that you haven’t even considered asking but must be asked for you to make informed decisions, have peace of mind, control, power, and influence.
When I talk to doctors and nurses directly with you or with your family, or one-on-one with them, the dynamics will change in your favor because they realize they have nowhere to hide, and you have someone on your team that understands intensive care inside out.
Now, I also represent you in family meetings with intensive care teams so that you don’t get walked all
over, and that you have again, clinical representation in family meetings making sure you have advocacy, consulting, and guidance.
We also offer medical record reviews in real time so that you make informed decisions that you have peace of mind, control, power, and influence and so that you can get 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 suspecting medical negligence.
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 support@intensivecarehotline.com with your questions.
If you like my video, subscribe to my YouTube
channel for regular updates for families in intensive care, click the like button, click the notification bell, comment below what you want to see next, what questions and insights you have, share the video with your friends and families.
Thanks for watching.
This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.
Take care for now.
