Quick Tip for Families in Intensive Care: One-Way Extubation After Hemorrhagic Stroke in ICU? Why It Might Be Too Soon to Give Up!
Update: 2025-09-01
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Quick Tip for Families in Intensive Care: One-Way Extubation After Hemorrhagic Stroke in ICU? Why It Might Be Too Soon to Give Up!
“One-way extubation after hemorrhagic stroke in ICU, why it might be too soon to give up?”
My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.
Today, I want to talk about a 51-year-old man who has been in ICU for 14 days after suffering a hemorrhagic stroke. He had high intracranial pressures (ICP), also known as ICPs, a midline shift, and an external ventricular drain (EVD) placed to manage the pressure. He was heavily sedated and paralyzed with fentanyl, midazolam, propofol, and cisatracurium. He was also on hypertonic saline to help reduce brain swelling.
Two weeks later, sedation and opiates have been stopped for 48 hours since the Glasgow Coma Scale, also known as GCS), is between 3 and 6. He’s currently ventilated on CPAP (Continuous Positive Airway Pressure) with the following ventilator settings, FiO2 (Fraction of inspired Oxygen) 30%, PEEP (Positive End-Expiratory Pressure) of 5, pressure support of 10, tidal volumes is around 500mL, minute volumes around 13L per minute, respiratory rate around 23 breaths per minute, that means he’s passing spontaneous breathing trials.
The ICU team wants to go down the path of what they call a “one-way extubation, meaning they plan to remove the breathing tube and not reintubate him no matter what happens. This is essentially an end-of-life measure without ICU teams naming it so.
But here’s the problem. Why has a tracheostomy not been mentioned and why is the tracheostomy not on the table? This particular patient has a cough, but likely not strong enough to prevent aspiration after extubation. Despite that, no one is talking about a tracheostomy, which is a common next step for patients who are not ready to be exubated, but are also not ready to die.
This man’s family is not ready to give up, and frankly, why should they? He’s breathing spontaneously, maintaining good minute volumes and he’s tolerating minimal ventilator settings, yet the ICU team is pushing to remove life support by doing a one-way extubation without giving him the chance to survive with a tracheostomy without giving him time.
Just for the record,
Quick Tip for Families in Intensive Care: One-Way Extubation After Hemorrhagic Stroke in ICU? Why It Might Be Too Soon to Give Up!
“One-way extubation after hemorrhagic stroke in ICU, why it might be too soon to give up?”
My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.
Today, I want to talk about a 51-year-old man who has been in ICU for 14 days after suffering a hemorrhagic stroke. He had high intracranial pressures (ICP), also known as ICPs, a midline shift, and an external ventricular drain (EVD) placed to manage the pressure. He was heavily sedated and paralyzed with fentanyl, midazolam, propofol, and cisatracurium. He was also on hypertonic saline to help reduce brain swelling.
Two weeks later, sedation and opiates have been stopped for 48 hours since the Glasgow Coma Scale, also known as GCS), is between 3 and 6. He’s currently ventilated on CPAP (Continuous Positive Airway Pressure) with the following ventilator settings, FiO2 (Fraction of inspired Oxygen) 30%, PEEP (Positive End-Expiratory Pressure) of 5, pressure support of 10, tidal volumes is around 500mL, minute volumes around 13L per minute, respiratory rate around 23 breaths per minute, that means he’s passing spontaneous breathing trials.
The ICU team wants to go down the path of what they call a “one-way extubation, meaning they plan to remove the breathing tube and not reintubate him no matter what happens. This is essentially an end-of-life measure without ICU teams naming it so.
But here’s the problem. Why has a tracheostomy not been mentioned and why is the tracheostomy not on the table? This particular patient has a cough, but likely not strong enough to prevent aspiration after extubation. Despite that, no one is talking about a tracheostomy, which is a common next step for patients who are not ready to be exubated, but are also not ready to die.
This man’s family is not ready to give up, and frankly, why should they? He’s breathing spontaneously, maintaining good minute volumes and he’s tolerating minimal ventilator settings, yet the ICU team is pushing to remove life support by doing a one-way extubation without giving him the chance to survive with a tracheostomy without giving him time.
Just for the record,
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