Medical Author: Maureen Welker, MSN, NPc, CCRN
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
Let us first address the topic of life support. The term "life support" can mean different things to different people. Usually when one speaks to "life support" they are referring to a type of breathing machine, what we call a ventilator. (For example, other means of life support include cardiopulmonary bypass during open heart surgery, kidney dialysis, etc.) A ventilator is a way of administering oxygen to a patient, which is considered a drug. The ventilator is connected to the patient by a network of tubing. The patient will have a tube called an endotracheal tube that is usually placed into the mouth and passed into the large airways of the lungs. One of three types of endotracheal tubes may be used:
- orotracheal is located in the mouth,
- nasotracheal is located in either the right or left nostril of the nose; and
- tracheostomy is an opening into the trachea and is performed by a small surgical incision in the neck area.
The ventilator is used when a patient needs to be completely relaxed and/or requires frequent and higher than normal doses of sedation on a temporary basis. The particular reason for using a ventilator will vary depending upon the medical condition and status of the patient. Some examples of why a patient may need the support of a ventilator include patients who have had extensive surgery, traumatic injuries (such as brain injuries), or severe lung infection or disease.
Many factors will determine the level of consciousness of the patient; the critical care staff can give you valuable information on the exact status of your loved one. Patients medicated with narcotic drugs who are ill may sleep most of the time and have a decreased level of consciousness. Narcotics drugs or sedation medication are used to decrease the patient level of anxiety and create a relaxed state for the ventilator patient, which also can decrease the patient's ability to breathe adequately. The ventilator is used to provide the patient adequate and efficient oxygen and ventilation to the lungs. A ventilator is not a cure for the patient but a temporary supportive devise that supports the healing process.
The type of illness or injury the patient has, and the medications being used will determine the level of consciousness or how alert the patient is. An injury to the head may have caused some damage to the auditory system affecting the patient's ability to hear. This can affect the patient's ability to hear any auditory communication from others and may mandate non-verbal skills in communicating with staff and family members.
Many studies have been conducted in critical care units to support the importance of communication with patients, and the positive outcomes of the patient healing as a result of communication. So, if you ask if your loved one can hear you, the answer is YES! They do hear you, so speak clearly and lovingly to your loved one. Patients from Critical Care Units frequently report clearly remembering hearing loved one's talking to them during their hospitalization in the Critical Care Unit while on "life support" or ventilators. I encourage you to communicate with your loved one.
An important fact to remember is; always check with the critical care staff member in charge of your loved one's care to obtain proper guidance on what type of communication is appropriate for your loved one at the time of your visit, as many times stimulation can be harmful at particular critical periods of healing. The critical care staff is highly trained and can guide you in what is appropriate for your loved one's condition, as a patient's status can change quickly during the critical care period. Be reassured you are surrounded by caring staff in the Critical Care Unit.
On a personal note, I would like to share with you one of my experiences as a trauma/critical care nurse - an example of another type of communicating and hearing. Sally was a lovely 77 year old lady in the Critical Care Unit on a ventilator with many IV medications to keep her alive. Sally was dying of terminal cancer. After a long battle, Sally's family and doctors decided not to interfere if Sally's heart should stop, but to continue with her present care.
I had taken care of Sally many times in the Critical Care Unit and this day was no different. I arrived in the Critical Care Unit early that morning and said "Good morning" to Sally, told her the date and time of day and spoke to her when I had a task to perform on her. Sally was very weak, unable to move and had not responded in over 45 days. At 10:00 am Ed, Sally's husband arrived and sat in his usual chair next to Sally's bed. Ed kept a journal of all of Sally's daily events and progress, as well as read some of their favorite prayers. As Ed sat and updated his journal, I noticed Sally's blood pressure and heart rate were continually dropping. I notified Ed that this would be the end of Sally's life, and prepared him for what was to come.
Ed quickly left the room to call the couples daughter, Laura, who lived 45 minutes south of the hospital. Ed returned to Sally's room and announced that Laura would arrive at the hospital in about one hour. Sally's vital signs continued to drop. I held Sally's hand and told her that Laura was on her way and would be there in one hour. Immediately Sally's blood pressure and heart rate returned to normal. Puzzled by this, Ed looked at me wondering what was happening. I told Ed that Sally heard us and knew that Laura was on her way. Ed looked at me wanting to believe me, but a bit doubtful. Ed sat and continued to record Sally's vital signs, amazed at how stable she had quickly become. Ed and I spoke to Sally from time to time reassuring her that Laura would be arriving soon. Ed told Sally how much he loved her, and recalled some of the precious memories from their marriage. Laura arrived one hour later, walked over and hugged her father, Ed. Laura then immediately walked over to her mother, Sally, and said "Mom, I'm here, I love you." Sally's heart stopped seconds after hearing Laura's voice.
In the Critical Care Unit my patients taught me we not only hear with our ears, but also with our soul. We learned to speak to each other, because we had forgotten how to communicate. Different types of miracles happen every day in the Critical Care Unit-this was the miracle of a mother and wife's love for her family. Sally wanted Ed to have their daughter with him. So yes, they are listening to us when we speak.