ICU keeps telling me that they can't take my loved one off the ventilator due to agitation! Help!

https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-icu-keeps-telling-me-that-they-cant-take-my-loved-one-off-the-ventilator-due-to-agitation-help/

Quick tip for families in ICU: ICU keeps telling me that they can't take my loved one off the ventilator due to agitation! Help!

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

So, one of our readers is saying, “My loved one has been in intensive care for two weeks after a pneumonia and now, they’re not waking up due to agitation. Whenever the ICU team is trying to take off sedation, they are agitated and they’re fighting against the ventilator. They’re not helping with coming off the ventilator by not obeying commands, by not following instructions.” So, this happens all the time in ICU.

And again, the biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care. And this is exactly what this situation presents for you.

So basically, what’s happening is here, that your loved one has been in a coma for too long. They would’ve been on substances, such as morphine, fentanyl, potentially midazolam or Versed, propofol, Precedex, ketamine, or a combination of all of that and that’s presenting numerous challenges. For example, it presents that some of those substances are addictive in nature. And when your loved one is waking up, they’re potentially withdrawing from those substances and that therefore, they get agitated. It’s a bit like if someone is being weaned off from drugs, or alcohol, or any other toxic substances, people are going through withdrawal and it’s sort of a similar situation often in those situations.

And also bear in mind, your loved one has been chemically restrained more or less for the last two weeks. If they’re waking up, they have no idea what’s happened. They’re in a foreign environment and strange people around them. It would be very distressing for them. And the way forward is often to try and try again, manage the withdrawal potentially with some medications such as Clonidine, but also by talking to your loved one and explaining to them what’s happening, what they need to do, that they need to breathe with a ventilator and, explaining things to them with much patience, starting some physical therapy or physiotherapy, starting to move them.

And I assume the pneumonia is healed. You haven’t mentioned that but also making sure that the pneumonia is healed. And then if the ICU team thinks, maybe there is a neurological event, i.e., the brain isn’t working, then one of the next steps is also to do a CT scan of the brain. Maybe do an EEG, making sure there hasn’t been a neurological event, such as a stroke. There haven’t been any seizures and go from there. This is often a bit of a waiting game, and it takes numerous attempts often.

Now, if all of that fails, then often the next step is to do a tracheostomy and wean your loved one off from there. But ideally, a tracheostomy is avoided because ideally, your loved one can just breathe on CPAP pressure support and then being taken off the ventilator.

That is my quick tip for today.

If you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website, or simply send us an email to support@intensivecarehotline.com.

Also, have a look at our membership for families in intensive care at intensivecaresupport.org.

If you need a medical record review, please contact us as well. If you need a medical record review for your loved one, or for yourself after intensive care or while your loved one is in intensive care, you should contact us.

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