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Today’s article is about, “Quick Tip for Families in Intensive Care: Is My Sister in ICU Going to Die if She's Failing Extubation After Clavicle, Rib, & Ankle Fracture?”

You may also watch the video here on our website https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-is-my-sister-in-icu-going-to-die-if-shes-failing-extubation-after-clavicle-rib-ankle-fracture/ or you can continue reading the article below.

Quick Tip for Families in Intensive Care: Is My Sister in ICU Going to Die if She's Failing Extubation After Clavicle, Rib, & Ankle Fracture?

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

So today, I’ve got an email from Diane who says, “My 52-year-old sister is in ICU, and they want to take her off the ventilator this morning but couldn’t because she was too agitated. So, they made her go to sleep again and said they would try again tomorrow morning.

My sister suffered from a fall and broke her clavicle, some ribs, and her ankle and was in a lot of pain. My sister is also suffering from alcoholic dementia. I am worried that she will die tomorrow because the doctor told me he talked with my sister, and they said to not reintubate her if she’s agitated again for a second time tomorrow.

There is nothing I can do to change their minds. They say she’s not competent enough to make the decision. But when I asked her this morning if she wanted to stay alive, she said yes with her head. Yesterday, she wrote me a note asking to have a TV to watch because she had nothing to do. This doesn’t sound like a person that is not competent. I’m very worried she will die tomorrow. I am her next of kin.” Thank you, Diane for sharing this.

There’s a number of things here. You shouldn’t be too concerned about the ICU team letting her die. What you should be concerned about is controlling what you can control, especially if you’re the next of kin. If they let her die tomorrow and not save her life, that could be perceived as murder. I don’t think that’s what’s going to happen here.

I think what is going to happen is she’s suffering from getting off the ventilator. Many patients in ICU do suffer from that. With broken ribs, broken clavicle, fractured ankle, and a lot of pain patients generally speaking, are not going to die.

Now, you are saying she’s got alcoholic dementia as well. So, I don’t know whether she’s got any liver damage from that and potentially there could be complications from that if she is in liver failure.

However, if she is talking to you and she’s talking to them, that is a very good sign, and that also means she might be able to be talked through the extubation. So, what that means is when they take out the breathing tube.

Certain things need to happen before you can take out the breathing tube, the patient needs to be awake, needs to be able to obey single commands such as, can they squeeze your fingers, wiggle their toes? Have they passed the spontaneous breathing trials? Are the arterial blood gases within normal range? Do they have a good cough or gag reflex? Are they awake? And your sister is awake. So, that means if they take off sedation, hopefully, next time around they can talk her through the extubation process.

Now, if she’s got dementia, that might throw a spanner in the works, but it sounds to me like she’s talking to you appropriately. That is a good sign. The question here also is, is she potentially going through withdrawal?

Again, if she’s potentially alcohol dependent, is she going through alcohol withdrawal while she’s in ICU? If so, what are they doing about it? Is that part of the issue why she’s not waking up and why she can’t be weaned off the ventilator?  Have they made her potentially too drowsy to wean her off the alcohol as well?

So, for example, what I’ve seen with patients that go through withdrawal in ICU while they’re on a ventilator and they go through substance withdrawal, whether it’s alcohol or drugs or any other medication, you often need to counteract that with other medications such as sometimes Diazepam or Benzodiazepines, which then delays waking up.

So, that’s why it’s so important in a situation like that, that you do get a second opinion and that you also exercise your rights about. If you are the next of kin, they can’t just let your sister pass away without your consent, assuming there is no advanced care plan where your sister would say, “Oh, she wants to die.” If you’re letting someone die that can say to you, they want to live. Well, again, I argue that would be perceived as murder. So, they have to put the brakes on, and they have to make sure they’re doing all the right things.

So, it’s very important that you get a second opinion. It’s very important that you have an advocate speak to them directly, which is what we do here at intensivecarehotline.com. It’s very important that you have myself or my team look over the medical records, making sure they’re doing all the right things, looking at blood results, looking at an arterial blood results, looking at what ventilator settings she’s on. It’s also very important in a situation like that and looking what medication she’s on. Really, really important in a situation like that.

If they still want to “kill” your sister, that would just be wrong. Like I said, the best way is to give me a call on one of the numbers on the top of our website at intensivecarehotline.com, and then I can deal with this pretty quickly. We have saved many lives in similar situations before.

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

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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.

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