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 our readers and the question last week
was
"MY MOTHER IS IN INTENSIVE CARE VENTILATED WITH SEVERE FLU! THE DOCTORS WANT TO PERFORM A TRACHEOSTOMY AND THEY ARE NOT ANSWERING MY QUESTIONS! 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 from one of our readers and the question this week is
MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO? (PART
1)
Hi Patrik,
my partner
is intubated and has been for 2 weeks and he has been blind for 4 years. He passes the weaning trials but he gets a little agitated and his blood pressure rises. His main line came out and he
was off all meds for several hours and I was able to calm him down. The doctors want a tracheostomy and feeding tube. I want to have him extubated!
I believe the sedation and just the
situation is scary. What do I do? I don't think they are lowering the sedation enough or allowing it enough time to wear off before trying to make him follow commands.
He was admitted to hospital December 2nd with Pneumonia.
He was moved to ICU and intubated on December 5th with bacterial pneumonia MRSA
On December 15th a ct scan was done and lesions on his right lung (I'm assuming the empyema) were discovered.
On December 16 he
was extubated for the first time.After he was extubated he was delirious.
He was not given any more pain meds. They gave Geodon and Ativan to calm him. They also stopped antibiotics.
He was delirious when he was intubated and after. I
don't think he regressed I think he was still very sick and in pain.
On December 22nd I had him moved to a different hospital where he was re-intubated before I arrived. Evidently they weren't even informed he had been in ICU at the other hospital.
He is still intubated.
He throws his hands up I don't even know if it's voluntary it's almost like he's dreaming that something is coming at him.
He does bite the tube he only has bottom teeth.
On December 26th they put in a chest tube to try to drain the infection.
He had/has Empyema and Pneumonia they did surgery
on him December 31st and he did well afterwards.
The drain tubes are out and the thoracic surgeon signed off. He had kidney issues the kidney doctor signed off out today also.
Anyway in total he was intubated 11 days with Pneumonia.
Then he was off the ventilator for 7 days
Then he was Re-intubated 14 days from now with Pneumonia and what they thought was Tb or a fungal infection. It turned out to be Pneumonia and empyema.
Also they are giving him Diprivan and fentanyl for sedation and Seroquel in his feeding
tube.
From what I have read he probably doesn't even remember coming to the hospital. He became kind of delirious before intubation.
He was delirious the seven days when he was extubated but had been taken off pain meds and antibiotics. He had lots of mucus and no eating or drinking and no physical therapy. He was still very sick.
Hallucinations and delirium are symptoms of his illness and side effects of some of his meds. He was still very sick when he was extubated and they really just stopped treating him.
I don't think he regressed because of being extubated, I think he was not
property diagnosed and treated.
He passes weaning trials and gets agitated. I am sure he is very much afraid. He is clinically better. I think given his circumstances agitation is natural and I think if he is off the ventilator then some of the meds won't be
necessary and his mental state will improve.
Whereas now he still doesn't know understand or remember what is going on. For all he knows he has just woke up in a something you see in a horror movie!
A tracheostomy may be better than the mouth tube but I think we could take a chance and see if his mental state improves after being extubated.
I think a
tracheostomy would just be another scene. He needs to be able to communicate and to be communicated with, to fully grasp what's going on.
He can't do that due to panic I am sure. He is blind and has to have faith that what everyone saying is true and I don't think on the
middle of all of this that is going to happen, I also think adding something else traumatic isn’t going to help.
I think he can breathe by himself and I think pulling that tube out would let him catch his breath and start helping him move around and get the medications out of
his system. With that we'll gain his trust and he'll gain his physical and mental health.
Thanks Heather
Dear Heather,
thank you for clarifying and writing in such
detail.
Now I’ve got a good picture to guide you.
And once
again, well done for standing up, have a say and seeking out help!
Most families of critically ill Patients in Intensive Care don’t seek out for help, they don’t do their own research and as a result they have no PEACE OF MIND, no control, no power and no
influence! If anything they are intimidated by the “perceived power” and the “perceived authority” of the Intensive Care team!
You and your partner must have had a terrible time over the last few
weeks with what you are describing and it’s good that you want to take the next steps.
Know this.
From what you are describing, I would say that doing a trial extubation without a tracheostomy seems the right thing to do.
The Intensive Care team may well argue that given your husband’s history with multiple failed extubations and multiple re-intubations since December 2nd he will have a high chance of failing extubation again and he’ll end up with a tracheostomy anyway.
But you should listen to your inner voice, to your intuition and to your gut feeling because you know your partner best and you know how he’ll deal with challenges!
If you think he should have another trial extubation then you should make that very clear
and not have it any other way!
From what you are describing I can see challenges that may well stand in the way of your partner getting successfully extubated, such as his relatively long ICU stay (1 month), his confusion and maybe his blindness, although his blindness shouldn’t
stop him from breathing without the ventilator if people communicate well.
The confusion of your husband that you are referring to, as well as his physical and mental health are certainly challenges, however they can be overcome with the right strategies.
Often, delirium, confusion and agitation in Intensive Care don’t go away overnight and they need to be managed appropriately.
Check out this article for more information about delirium in ICU:
The 5 things you need to know if your loved one is confused, agitated and
delirious in Intensive Care
Again, there are some challenges that your partner is dealing with that leave room for him needing a tracheostomy, such as his confusion and delirium!
However more than that I think given his many ups and downs since admission to Intensive Care over the last month, also leave room for your partner needing the tracheostomy.
However I strongly believe you should be pushing for the trial extubation first and then take everything from there.
You are correct to point out that your partner would be extremely anxious and it is a nightmare situation!
If the trial extubation goes well, everybody wins!
If the trial extubation
fails and your husband will need a tracheostomy, he may still come good because after the tracheostomy has been inserted, your husband won’t need as much sedation (like Diprivan and Fentanyl), because the tracheostomy tube is much easier to tolerate compared to a breathing tube through the mouth.
A tracheostomy certainly has some benefits and only after a trial extubation has been deemed unsuccessful.
You are also referring to trust! Trust is extremely important, however as you have also pointed out correctly, most critically ill Patients in
Intensive Care will not remember much, if anything about their stay in Intensive Care.
Whilst it’s horrible to watch your loved one suffer, rest assured that your partner won’t remember much of his ICU stay.
Also, you also might have to challenge the Intensive Care team about their intentions, for example, why are they so adamant of doing the tracheostomy straight away without the trial extubation?
Are there some monetary/ financial incentives to do it straight away? Do they want to keep the ICU bed occupied because they are quiet at the moment?
If they extubate your husband successfully he might
leave ICU relatively quickly and they may miss out on payments/ funding for an expensive ICU bed.
There may well be legitimate reasons to perform the tracheostomy however you need to get comfortable to challenge the Intensive Care team, watch their reaction and get to the
“bottom of things” quickly!
You will only be able to get to such a deep level of PEACE OF MIND , control, power and influence if you are not intimidated by the Intensive Care team’s ”perceived
power” and ”perceived authority”!
In order to successfully manage the Intensive Care team, so that they don't manage you, you should be looking at our FREE information to get strategies about managing the Intensive Care team successfully and
efficiently. You can do so with our FREE "INSTANT IMPACT" report that you can download here by entering your email address here (click on the link)
IMMEDIATE ACTION STEPS
I hope that
helps Heather, here are some related articles that you should check out as well that will help you to make an informed decision when it comes to ventilation and tracheostomy!
I can also be available for a FREE 20 minute Skype consultation, my SKYPE ID is patrik.hutzel
Your friend
Patrik Hutzel
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Your Friend
Patrik Hutzel
Critical Care
Nurse
Founder& Editor
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