Hi, it's Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we INSTANTLY improve the lives of Families of critically ill Patients in Intensive Care, so that you can have PEACE OF MIND, real power, real control and so that you can influence decision making FAST, even if you're not a doctor or a nurse in Intensive Care!

In last week’s BLOG I shared with you

“HOW TO CONTROL YOUR POSITIVE SELF- IMAGE whilst your loved one is critically ill in Intensive Care!”

You can check out last week’s BLOG by clicking on the link here.

In this week’s BLOG I want to teach you

HOW TO STOP BEING HELD HOSTAGE BY THE

INTENSIVE CARE TEAM if your loved one is

critically ill in Intensive Care!

If your loved one is critically ill in Intensive Care and if your loved one is facing one of those challenging, difficult and heartbreaking situations where they are either

• very unstable and in a very critical condition

• in a life threatening situation

• in Intensive Care for long-term treatments and long-term stays

• having a severe(traumatic) head or brain injury

• THREATENED with an “NFR”(Not for resuscitation) or “DNR”(Do not resuscitate) order

• In a situation where the Intensive Care team suggests a “withdrawal of treatment” or a “limitation of treatment” as being “IN THE BEST INTEREST” of your critically ill loved one

• approaching their end of life in Intensive Care

the tension tends to be extremely high!

The tension is palpable and more often than not, Families of critically ill Patients in Intensive Care in those situations feel like they are held hostage in a situation that they wish they’d rather never encountered in the first place.

But let’s face it, given that you are here, you are most likely in this “ONCE IN A LIFETIME” situation!

The Intensive Care team is used to “calling the shots”

More often than not Families of critically ill Patients in Intensive Care feel like they are held hostage by the Intensive Care team, because after all, the Intensive Care team is “calling the shots” so to speak, the Intensive Care team is driving the bus and the Intensive Care team, with their positioning as the “perceived power” and the “perceived authority” is more or less driving their agenda in those situations!

If Families of critically ill Patients in Intensive Care don’t feel like they are held hostage by the Intensive Care team in those situations, then they certainly haven’t fully embraced what they are dealing with, they haven’t fully embraced what is at stake and they haven’t fully embraced that there are far too many wheels in motion “BEHIND THE SCENES” in Intensive Care that impacts on how the Intensive Care team positions your critically ill loved one’s prognosis and diagnosis!

Let’s look at a real world example

Now, let’s say that your critically ill loved one has been admitted to Intensive Care after they had a cardiac arrest while they were playing golf or while they were out shopping.

Your critically ill loved one is 75 years of age and generally speaking has been enjoying a good quality of life until now.

Your critically ill loved one has been placed on a ventilator and in an induced coma for at least the next 24-28 hours to minimise body functions and to therefore increase and maximise chances of recovery.

When your critically ill loved one’s heart stopped, thankfully some bystanders commenced CPR (Cardiopulmonary resuscitation) immediately, but nobody really knows how effective this CPR was until the ambulance arrived.

The paramedics continued CPR at the scene and they also found that your critically ill loved one had no heart rhythm when they first arrived after about 10-15 minutes after the alarm was raised.

After continuing CPR, the paramedics eventually got your critically ill loved one’s heart rhythm back and they then transferred them to Intensive Care.

After you received the unexpected phone call from the Intensive Care Unit you and your other family members have rushed to the hospital to see your critically ill loved one in the induced coma.

You and your family feel extremely stressed, overwhelmed, frightened, scared, vulnerable and worst of all you feel a loss of control.

A few hours into the ordeal, the Intensive Care team wants to meet with you and you and your family are now sitting in the Intensive Care meeting room with a senior doctor, a junior doctor and the bedside nurse being present.

The  most senior Intensive Care doctor opens the meeting by summarising that your critically ill loved one has had a major heart attack. This has been confirmed in various tests, including ECG’s, blood tests and ultrasound. Your critically ill loved one is currently too unstable to have an angiogram to have an even closer look at the heart to find out what exactly may have caused the cardiac arrest.

The most senior consultant also highlights that the prolonged CPR given by bystanders may not have been effective and that therefore brain damage can not be ruled out due to lack of oxygen to the brain.

Related article:

What is the prognosis after my critically ill loved one’s brain has not had sufficient oxygen supply(hypoxic brain injury)?

Overall, the most senior doctor in the room is painting a “doom and gloom” and rather negative picture of the situation that your critically ill loved one is in.

He also mentions that further testing may be done, however he is also mentioning that your critically ill loved one is “quite old” and that it’s most likely that they wouldn’t have any quality of life to go back to after such a massive event!

He also goes on to say that further testing may not be “IN THE BEST INTEREST” of your critically ill loved  one,  as he once again highlights his opinion that your critically ill loved one is “quite old” and most likely wouldn’t enjoy the quality of life they had before the cardiac arrest.

The most senior doctor then asks you and your family whether you are understanding the situation and whether you have any questions.

In the meantime, you and your family are sobbing uncontrollably.

A few hours ago, you, your family and your critically ill loved one enjoyed life and now the situation has changed dramatically without any warning!

You feel like the world is tumbling down on you.

You also feel like you have been presented with cold hard facts, without you actually having the opportunity to have your say!

Let’s zoom out of this fictional conversation and let’s take a breather for a minute.

What has happened?

Your critically ill loved one is in Intensive Care after cardiac arrest. They are very sick and their fate and destiny at this point is unknown.

The Intensive Care team has “framed” the situation that supports their hidden agenda

The Intensive Care team has been framing your critically ill loved one’s situation as very negative and they have been painting a “doom and gloom” scenario.

They have positioned your critically ill loved one’s diagnosis and prognosis in a way that sets low expectations.

The Intensive Care team has positioned themselves so that anything from now on may appear as a benefit and most importantly they have positioned your critically ill loved one’s diagnosis and prognosis in a light that will support the Intensive Care team’s mainly hidden agenda!

This mainly hidden agenda of the Intensive Care team when it comes to critically ill Patients in Intensive Care being either

• very unstable and in a very critical condition

• in a life threatening situation

• in Intensive Care for long-term treatments and long-term stays

• having a severe(traumatic) head or brain injury

• threatened with an “NFR”(Not for resuscitation) or “DNR”(Do not resuscitate) order

• In a situation where the Intensive Care team suggests a “withdrawal of treatment” or a “limitation of treatment” as being “in the best interest” of your critically ill loved one

• approaching their end of life in Intensive Care

generally speaking supports the interests of the Intensive Care team, irrespective of the challenges, difficulties and heartbreak you, your family and your critically ill loved one are facing!

The Intensive Care team is protecting their own turf first and foremost

The Intensive Care team will always protect their own turf first and foremost and that means that the Intensive Care team will look at

• their financial and monetary interests $$$ if and when treating your critically ill loved one

• the bed situation in Intensive Care, i.e. are they under pressure to admit other critically ill Patients into scarce, expensive and precious Intensive Care beds

• their medical research interests, i.e. will treating your critically ill loved one to the best of their abilities support their medical research interests and therefore generate multi-million dollar $$$ per year funding or is it in the Intensive Care team’s interest to shrewdly and adeptly “sell” you on a “withdrawal of treatment” as being “in the best interest” of your critically ill loved one, because continuing treatment on your critically ill loved one doesn’t support their medical research interests?

• the politics, the dynamics, the competing interests, the power play and power struggles, the intrigue and the psychology in Intensive Care

• resources allocated to other critically ill Patients and whether there are enough resources to give your critically ill loved one the best care and treatment

The Intensive Care team is literally holding you hostage by their positioning

Therefore, if you and your family are unaware of the dynamics, the psychology, the competing interests, the power play and power struggles, the dynamics, the intrigue and most of all what’s happening “BEHIND THE SCENES” in Intensive Care, the Intensive Care team will literally hold you, your family and your critically ill loved one hostage.

The minute you and your family know and understand that what’s happening “BEHIND THE SCENES” in Intensive Care is way more powerful than anything else that is happening in Intensive Care, that’s the minute when you will separate yourself from the 99% of Families of critically ill Patients in Intensive Care who have no PEACE OF MIND, no control, no power and no influence!

The minute you and your family understand that you need to take responsibility for the outcomes you are going to get when your loved one is critically ill in Intensive Care and the minute you understand that it’s not what’s happening to you and your family, but that it’s how you react to what’s happening to you, to your family and to your critically ill loved one, that’s the minute when you will have PEACE OF MIND, control, power and influence!

Also, check out our "YOUR QUESTIONS ANSWERED" section

where I answer all of YOUR questions

http://intensivecarehotline.com/category/questions/

Hi, it's Patrik Hutzel from INTENSIVECAREHOTLINE.COM  , where we INSTANTLY improve the lives of Families of critically ill Patients in Intensive Care, so that you can have PEACE OF MIND, real power, real control and so that you can influence decision making FAST, even if you're not a doctor or a nurse in Intensive Care!

This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from one of our readers and the question last week was

 "My husband is quadriplegic and has been off the ventilator for more than two weeks! The Intensive Care team wants to send him home with a tracheostomy but I don’t believe he’ll need the tracheostomy! Help!"

You can check out the answer to last week’s question by clicking on the link here.

 In this week’s episode of “YOUR QUESTIONS ANSWERED”  I want to answer another question that our readers ask quite frequently and the question this week is

"WHAT HAPPENS IF MY CRITICALLY ILL

LOVED ONE CAN'T BE WEANED OFF THE

VENTILATOR?"

Having a loved one critically ill in Intensive Care is a very challenging situation to be in. Your worst nightmares, you worst fears, your frustrations, your emotions and your vulnerability are at an extreme level!

You are literally in a “ONCE IN A LIFETIME” situation!

After more than 15 years Intensive Care nursing experience in three different countries and after I have literally worked with THOUSANDS of critically ill Patients and their Families I have found that one of the most frustrating things to watch in Intensive Care is when your critically ill loved one is attached to a ventilator and can’t be weaned off.

And here I need to give you some perspective!

Being in a situation where your critically ill loved one can’t be weaned off a ventilator can come in different facets and different situations.

Let’s shed some light on these different situations where your critically ill loved one can’t be weaned off a ventilator.

1. Your critically ill loved one is in an induced coma and has been in Intensive Care for a few days

Now if your critically ill loved one has been in Intensive Care for a few days or up to a week and was initially induced in a coma and is now at the point where they are ready to be “woken up”, it can sometimes be tricky to predict how long it’ll take your critically ill loved one to “wake up” and taken off the ventilator.

Critically ill Patients after an induced coma tend to “wake up” in their own time, no matter how much we wish and hope for them to “wake up” quickly.

Sometimes it can happen quickly within a few hours, but that doesn’t mean that critically ill Patients are alert, coherent, responsive or even follow people’s instructions.

It can sometimes mean that critically ill Patients are restless, agitated, combative, aggressive and confused.

Think about it. If you came to Intensive Care for a critical illness, you were put on a ventilator and you were induced in a coma with strong sedatives(Propofol, Midazolam) and strong pain killers(Morphine, Fentanyl), you wouldn’t wake up smoothly either.

Therefore, “waking up” after an induced coma and weaning off the ventilator is more of a process and not an event. It’s more like switching on a light with a dimmer rather than switching on a light with a switch.

However, to answer your question, natural steps to wean your critically ill loved one off the ventilator is to stop, reduce or minimise sedation, change ventilator settings from a controlled mode, where the ventilator is doing all the work, to an assisted mode, where your critically ill loved one is taking steps to breathe by themselves so that they are basically ready to have the breathing tube removed.

This can sometimes take hours and it can sometimes take days.

It also depends on the underlying cause why your critically ill loved one came to Intensive Care in the first place, why they got ventilated and in the induced coma.

For example, if your critically ill loved one came to ICU with severe head injuries, seizures, stroke or other neurological conditions, “waking up” and weaning off the ventilator is often delayed and difficult as it is often more difficult to assess the neurological or cognitive functionality of your critically ill loved one.

As a rule of thumb, if critically ill Patients are “waking up” normally and they are coherent(i.e obey simple instructions), the ventilator should be weaned within 24- 48 hours and the breathing tube should come out.

If your critically ill loved one isn’t “waking up” even if sedation has been removed and it’s exceeding the 72 hour mark, you need to be patient. I know that’s easier said than done, but know that critically ill Patients tend to “wake up” in their own time.

If it’s coming to the 4- 7 day mark where your critically ill loved one still can’t be weaned off the ventilator, know there are a few options:

1. Do a trial extubation (removal of the breathing tube) and see whether your critically ill loved one can cope and breathe without the ventilator
2.  Consider re-sedation and induced coma to give your critically ill loved one a “rest”, more recovery time and wake them up later
3. Consider a Tracheostomy

That leads me to the second scenario where a critically ill Patient can’t be weaned off the ventilator

Related Articles

After weaning off a ventilator is it NORMAL to be confused?

How long does it take to wake up after an induced coma?

What is an induced coma and why is my critically ill loved one in an induced coma?

How LONG can someone stay in an INDUCED COMA?

How long does it take to wake up from a Traumatic brain injury or severe head injury?

How long can a breathing tube or endotracheal tube stay in?

2. Your critically ill loved one has a Tracheostomy tube, is ventilated and can’t be weaned off the ventilator

If your critically ill loved one has a Tracheostomy tube and is still ventilated you will be somehow familiar with the situations that I described in 1)

You and your critically ill loved one may have gone through some or all off the steps that I described in 1)

In any way, you, your family and your critically ill loved one are now facing the dilemma of having your critically ill loved one stuck in ICU with a Tracheostomy and on a ventilator.

It’s one of the most frustrating experiences for critically ill Patients and their families.

Patients tend to have no quality of life, they tend to have a disturbed day and night rhythm and they are often depressed!

Families of those critically ill Patients tend to face a massive dilemma too, because they often put their lives on hold by spending day and night in Intensive Care to be with their critically ill loved one!

Nevertheless, if your critically ill loved one is in Intensive Care with Tracheostomy and ventilator dependent, just like I mentioned in our 1^st scenario, critically ill Patients tend to wean off the ventilator in their own time. This can sometimes be over many days, weeks or even months.

Weaning off a ventilator with Tracheostomy in Intensive Care tends to be such a complex, challenging and difficult area that we have dedicated a standalone article just about this topic. I highly recommend that you continue reading this article here in order to get all your questions answered if your critically ill loved one is Intensive Care with a Tracheostomy and can’t be weaned of a ventilator: (click on the link)

Tracheostomy and weaning off the ventilator, how long can it take?

We also have numerous other FREE resources and articles as it relates to ventilation and Tracheostomy, so please check out these resources

Your friend

Patrik Hutzel

This is also our last update for this year! I will be back in the new year!

I wish you and your Families a merry Christmas and a happy, healthy and successful year in 2015!

I also wish for your loved ones who are in Intensive Care or on their way to recovery all the very best!

For those of you who may have lost a loved one in Intensive Care in an end of life situation, I really feel for you and for your Families!

I hope you can all find strength and meaning in what you've been through!

I also really want to thank you for your ongoing support and loyalty, the INTENSIVECAREHOTLINE.COM blog has almost doubled in growth over the last year and I really appreciate you taking the time, reading the information that I put out there for Families in Intensive Care!

If you want your questions answered just hit reply to this email or email me at support@intensivecarehotline.com and I'll answer your questions!

You can also send through your stories and share them on our BLOG for our readers! Just email support@intensivecarehotline.com or leave a comment on our BLOG

Or if you want to be featured on our podcast with your story, just email me at support@intensivecarehotline.com

FREE Video Mini- Course out now!

If you are interested in more FREE education and information if your loved one is critically ill in Intensive Care, I have created a FREE mini- course 

A BLUEPRINT for PEACE OF MIND, CONTROL, POWER& INFLUENCE whilst your loved one is critically ill in Intensive Care! 

The FREE Video Mini- course consists of 4 short videos that will educate you quickly and succinctly how you can have PEACE OF MIND, control, power and influence whilst your loved one is critically ill in Intensive Care.

You can sign up and get your first FREE Video here

http://intensivecarehotline.com/free-mini-course/

Also, our cutting edge new information PRODUCT will be released soon!

It has been a long time in the making, but because it's such an in-depth program it took some time and we are now only a few weeks away from releasing our first information product for Families of critically ill Patients in Intensive Care!

Our first cutting edge information PRODUCT that will help Families of critically ill Patients MASTER, take control, have power and influence in all of the most challenging situations in Intensive Care, even if their loved one is dying!

 The information product will be an "IN-DEPTH" education product for Families of critically ill Patients in Intensive Care and a SHORTCUT for Families to have PEACE OF MIND, control, power& influence! The focus of the education product will be on PEACE OF MIND, control, power and influence during the following situations in Intensive Care

• long-term stays in Intensive Care 
• end- of- life situations
• Family meetings with the Intensive Care team
• withdrawal of treatment situations and/or perceived medical futility
• what to do if your critically ill loved one is THREATENED with an "NFR"(Not for resuscitation) or "DNR"(Do not resuscitate) order
• severe head and brain injuries

The information product will be made available in Ebook, Video and Audio format so that our Customers can consume the information product in their chosen medium! 

Keep your eyes on news and updates for our cutting edge new information PRODUCT in the next few weeks!

The Ebooks, Videos and Audios will be a solution to the biggest and most challenging areas in Intensive Care for Families of critically ill Patients! 

Our cutting edge new information PRODUCT is a shortcut to PEACE OF MIND, control, power and influence for Families of critically ill Patients in Intensive Care!

If you have any questions about our upcoming products or if you have any suggestions 

please let me know at support@intensivecarehotline.com

Your Friend

Patrik Hutzel

Critical Care Nurse

Founder& Editor

WWW.INTENSIVECAREHOTLINE.COM