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Today's article is about, “Quick Tip for Families in ICU: Is My Husband Being Weaned Too Early from the Ventilator in ICU?”
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Quick Tip for Families in ICU: Is My Husband Being Weaned Too Early from the Ventilator in ICU?
My name is Patrik Hutzel from intensivecarehotline.com, where we instantly improve the lives for families of critically ill patients in intensive care by making sure you make informed decisions, have peace of mind, control, power, and influence, so that your loved one gets the best care and treatment always, even if you’re not a doctor or a nurse in intensive care.
In today’s video, I want to answer a question from one of my readers, Dominique, who says:
“Hi Patrik,
I feel they’re weaning my husband too early before he’s ready as he struggles to breathe when they reduce the ventilator. On the 3rd
day of testing my husband to breathe, I was there yesterday, and he struggled even more. He didn’t start breathing on his own. The nurse left the machine off for a while. I became highly anxious and worried. I said to the nurse to put the ventilator back on after 3 or 4 seconds, which was completely ignored, and they left it for about 10 seconds upwards before switching the ventilator back on, stressing my husband out.
They have been over-sedating him during his stay, despite his X-ray coming back clear. A few days ago, they took him down for another X-ray. Yesterday, it seems they are using any excuse they can to sedate him even when he didn’t need sedation or opiates. I’m worried they won’t be able to extubate him and that he needs a tracheostomy.”
Dominique, this is such an
important question, and I can tell you many families in intensive care face exactly this situation. First of all, weaning from the ventilator should not be rushed. If your husband is struggling to
breathe when support is reduced, that is a clear sign he’s not ready. A proper weaning process means monitoring blood gases, oxygen levels, tidal volumes, and respiratory effort, and not just let’s see “if he can breathe.”
Normally what happens is most patients in ICU start off on controlled ventilation, such as SIMV (Synchronized Intermittent Mandatory Ventilation) ACV (Assist Control Ventilation),
and then the rate is reduced maybe from 20 down to 15 down to 10. Then your husband can breathe more and more spontaneously, and eventually, he should be breathing spontaneously on the ventilator, on CPAP (Continuous Positive Airway Pressure), or on pressure support. That should be supported by physical therapy, reducing sedation, and minimizing sedation and opiates.
He can’t just, let’s see if he can breathe. There needs to be a weaning protocol. What you’re describing sounds more like a test than a proper medical assessment.
Also, you’re saying that your
husband has been taken down for chest X-rays, that he needed to be re-sedated for that. Now, that is dangerous in and of itself, here’s why. I have not worked in an ICU for a long time, where a patient needs to go downstairs or upstairs for a chest X-ray.
It can be done at the bedside in ICU, which makes the need for sedation and opiates much less.
Because if a patient goes for transport, they often need to be sedated, ICU patients in particular. And also, that sets him back and also the risk that the breathing tube is getting dislodged during a transfer is much higher. So, it’s ludicrous, really, and unsafe that your husband needs to go somewhere for a chest X-ray. And you are absolutely right to be concerned about oversedation and too many opiates.
Sedation is one of the biggest reasons in ICU that patients struggle to come off the ventilator. Now, common sedatives are propofol, midazolam, also known as Versed, or Precedex,
common opiates being used in ICU for mechanical ventilation of fentanyl and morphine. And the
combination of all of that often delays waking up and delays weaning of the ventilator.
The longer
someone is sedated and on opiates, the weaker their muscles get. The more difficult it is to breathe and the harder it is to wake up. Especially a lot of patients in ICU also go into kidney failure or liver failure and then it takes even longer to wake up. You should also ask if your husband has gone into kidney or liver failure or whether the kidneys or the liver are working well enough.
Now, regarding your concern about a tracheostomy, if a patient cannot be safely extubated within 7 to 14 days, a tracheostomy is usually the next step, and here’s why. A tracheostomy is more comfortable.
It requires less sedation and opiates, or none at all. It makes weaning easier. It reduces the risk of pneumonia, and it allows for earlier mobilization.
However, mobilization. should happen now as much as possible. Reduce sedation, reduce opiates. As long as your husband is tube-tolerant, he should be sitting on
the edge of the bed. He should even be sitting in a chair as long as he’s calm.
Unfortunately, many ICUs either delay a tracheostomy or push for premature extubation because of bed management, cost, and resource issues. But let me be very clear, this is not about what the ICU wants, this is about what’s best for your husband.
You need to take control, and here’s what you need to do. Ask for the weaning protocol, weaning parameters, and the criteria for weaning. Demand to see blood gases and ventilator settings before and after weaning trials. Question why sedation and opiates are still being used if your husband doesn’t need it. If they’re switching it off and your husband is tube tolerant, he can tolerate the ventilator he’s not in any pain, there should be absolutely no need to keep him sedated.
Ask directly whether he meets the criteria for extubation or whether
he meets the criteria for a tracheostomy. Ask them if they’re doing everything beyond the shadow of a doubt to wean him off the ventilator and the breathing tube and move him
towards extubation. Ask them if they’re doing everything beyond the shadow of a doubt to try and avoid the tracheostomy. Because you need transparency, not guesswork, you also need to have
access to all medical records, ASAP.
Get the physiotherapy
to do breathing exercises with him sitting on the edge of the bed, Also, have you asked them if extubating your husband onto BIPAP or CPAP or high flow nasal prongs is an option? There are some options for you.
So, Dominique, and for anyone watching this, if you feel your loved one is being weaned too early from the ventilator or not at all, if they’re being over-sedated or if you’re worried about extubation and tracheostomy decisions, reach out to us here at intensivecarehotline.com. We review ventilator settings,
sedation management, weaning plans and weaning protocols with you in real time so that you can make informed decisions, have power, really control, really influence over your loved one’s care in intensive care so they get best care and treatment always.
I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse manager for over 5 years in intensive
care. 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 because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our
intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.
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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.
