Quick Tip for Families in Intensive Care: What are the Best Questions to Ask for My Brother Who’s Been on a Ventilator in ICU for 14 Days?

A few days ago, I answered a question from a client who said, “My brother is in ICU on ventilation for 14 days. His blood gas exchange isn’t well; can he get better?” Today, I want to look at specific questions what to ask for a situation like that so you can be prepared if your family member is in a similar situation in ICU.

My name is Patrik Hutzel from intensivecarehotline.com. This is another quick tip for families in intensive care.

So today, we want to look at specific questions to ask the ICU team or prepare for a family meeting for a situation like that. The list of specific, respectful, of course, questions you can ask for your brother’s ICU team to advocate for his best care and treatment are, Number 1, questions about current status. What is the current cause of this poor gas exchange? Is it due to infection, inflammation, fluid buildup, scarring or even lung collapse? What do his recent arterial blood gas values show as for trends over the last 3 to 5 days, especially PaO2 (partial pressure of oxygen), PaCO2 (partial pressure of carbon dioxide), and pH (potential of hydrogen)? So, oxygen in the arteries, carbon dioxide in the arteries, and pH. Oxygen levels should be above 70 mmHg and PCO2 or carbon dioxide should be between 35 to 45 mmHg.

Next, how are his lungs responding to the ventilator settings? Are his lungs stiff? Is there low lung compliance? Is oxygenation improving with current settings?

Questions about next steps. Is a tracheostomy being considered? If not, why? Bear in mind, after 10 to 14 days on a ventilator with a breathing tube, a tracheostomy is often considered safer and better for recovery. Ask them if they’re aware of the timelines and criteria to decide when to perform a tracheostomy and the criteria is usually after 10 to 14 days off ventilation with the breathing tube and the inability to wean off a ventilator. I’ve written an article and made a video about, “How long can a patient be on a breathing tube before needing a tracheostomy?” and I will link to that video below the written version of this blog.

Next, have any steps been taken to start weaning off the ventilator? Ask about spontaneous breathing trials or sedation and opiate reduction.

Next, would your brother benefit from a transfer to a long-term acute care hospital? But that’s only if you are in the U.S. and it’s a question you should be asking. By the same token, I can tell you, do not go to an LTAC, but you should mention it before they mention it, and you should be prepared about it.

Then, questions about broader care. Is a pulmonologist, respiratory therapist, respiratory physician, or critical care specialist closely involved in your brother’s care? Are there any signs of ventilator associated pneumonia or other complications? And if so, are they being addressed? Is there anything more we could be doing right now to g...