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Today’s article is about, “Quick Tip for Families in Intensive Care: Should My 19-Year-Old Son on Ventilation & Tracheostomy Be Heavily Sedated with Opiates & Benzodiazepines”
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Quick Tip for Families in Intensive Care: Should My 19-Year-Old Son on Ventilation & Tracheostomy Be Heavily Sedated with Opiates & Benzodiazepines
Does your critically ill loved one really need to be intubated in ICU? And if they are intubated, do they really need to be on sedation? If you want to know the answer to that question, stay tuned. I’ve got the update for you.
My name is Patrik Hutzel from intensivecarehotline.com and this is another quick tip for families in intensive care.
At the moment, we are working with a client who has their 19-year-old son is in ICU after lung failure. He’s been on
ECMO (Extracorporeal membrane oxygenation) and has had a tracheostomy. One of the main purposes of a tracheostomy when weaning a patient off the ventilator in ICU is to minimize sedation.
Now, it turns out that this young man is still on fentanyl, ketamine, Valium (also known as diazepam), hydromorph, Precedex, and propofol, on truckloads of sedation, and there’s no need for that. Yes, he’s getting agitated when he’s waking up, but you have to manage that withdrawal because most likely, he’s going through withdrawal from addictive substances such as fentanyl, hydromorph or also the Valium. All addictive in
nature. So, when you go through the withdrawal, you need to gradually wean it off, and you might need to counteract it with medications such as clonidine, might help.
But before you even go there, the first question is, do you need sedation?
Shout out to my colleague, Kali Dayton, a nurse practitioner
in the United States. I’ve had Kali on my podcast, and she is from Kali Dayton Consulting.
She’s a nurse practitioner in ICU, and she has been advocating for no sedation in ICU for a long time. I think it’s great, the work that Kali is doing. This week, I saw a post from her on LinkedIn that I really want to tie in with our client at the moment. Kali posts on LinkedIn because it ties right in with our client here.
The first question is, why do patients need a
tracheostomy in the first place? Should we have avoided sedation and opiates in the first place to avoid a tracheostomy? Now, that’s not always possible, but it is possible in way more situations than you think.
Let me read out what Kali posted on LinkedIn this week. “If more patients look like the patient on the left than the patient on the right, I invite you to take a deeper dive.” Kali obviously puts patients in the LinkedIn post from intubated patients when awake, not when they’re not awake.
“Go talk to these patients and
ask yourself the following questions. Do they respond to voice? Do they have an indication for sedation? Is there a contraindication to mobility? Was an awakening trial done today, and how was it done? Why was sedation resumed? What RASS (Richmond Agitation-Sedation Scale) is charted versus what am I seeing at the bedside? Is this false documentation? Is this giving more medication than was prescribed?”
RASS is a sedation score
and you could actually get a RASS score from -3 to +3, +3 meaning the patient is fully awake, -3 the patient being fully sedated.
Then you need to titrate your sedation around the RASS score.
“Has this patient really been screened for delirium? Was it done properly?
Should we be depriving these patients of communication, autonomy, and mobility?” Let me repeat that. “Should we be depriving these patients of communication, autonomy, and mobility? Can we afford the significant costs in money, lives, and quality of life to treat all intubated patients this way? After you’ve answered all these questions, let’s chat. We’ll have a look and talk about it.”
Then Kali continues with another post. She addresses it to healthcare leaders, critical care directors, nurse managers, respiratory therapists, and rehabilitation directors.
“Please walk around your intensive care unit. Spend 30 minutes there during the day and soak it in. Please ask yourself the following: Are most to all
patients awake? Is sedation running? Is there a chair for them in the room? Is there a chair for them in the room? Is there a chair for them in the room? Are they out of bed and in the chair? Are the patients walking in the halls? Are intubated patients able to communicate with their loved ones and caregivers?”
This is where the rubber hits the road. If you see a loved one critically ill and
they’re sedated to their eyeballs, you’ve got to ask the question, why? What’s the agenda? And for someone with a tracheostomy, that should have never happened in the first place. So, Kali, shout-out to your work. It’s great.
For any families in intensive care, ask those questions to your ICU nurses and your ICU doctors, and we can help you with that.
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, and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section, and you can verify it on our intensivecarehotline.com podcast
section, where we have done client interviews, and you can watch the interviews there.
That is one of the many reasons why we are helping so many clients in Intensive care. We’ve helped hundreds of members and clients over the years to improve their lives instantly and making sure their loved ones in ICU get best care and
treatment.
That’s also why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever
medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly. I handhold you through this once in a lifetime situation that you simply can’t afford to get wrong. When I talk to doctors and nurses directly, I ask 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 you have unanswered questions, if you need closure, or if you are suspecting medical negligence.
All of that you get at intensivecarehotline.com where we also have a membership for families of critically ill patients in intensive care. 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. All of that will help you to make informed decisions, have peace of mind, control, power, influence, making sure your loved one gets best care and treatment, always.
All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send an email to support@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.
