I have a question from Rupa today who says,

“Hi Patrik, 

My mom had heart pumping only at 20 to 30%, so she had bypass surgery. After two days in ICU, she developed renal failure and one major cardiac arrest, but the heart revived after a few minutes. But currently the ICU team is saying my 68-year-old mom is in multiple organ failure for the past 2 to 3 days. She developed some fever and sometimes blood pressure drops, and she’s on a ventilator. 

What are her chances of recovery? How many days will she have to be on the ventilator and in ICU?”

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care. Here at intensivecarehotline.com, we instantly improve the lives for families of critically ill patients in intensive care so that you can make informed decisions, have peace of mind, control, power, and influence, making sure your loved one always gets the best care and treatment in intensive care, even if you’re not a doctor or a nurse in intensive care.

I have worked in critical care nursing for over 25 years in three different countries, where I worked as a nurse manager for over five years in intensive care, and I’ve been consulting and advocating for families in intensive care here at intensivecarehotline.com since 2013. I can very confidently say that we have saved many lives for our clients in intensive care. You can verify that on our testimonials section, as well as on our podcast section, where we have done client interviews at intensivecarehotline.com.

So today I’m responding to the question from Rupa, whose 68-year-old mom is in ICU on a ventilator following bypass surgery, cardiac arrest, renal failure, and now multi-organ failure with fever and dropping blood pressure. Rupa is asking what her mom’s chances of recovery are and how long she will need to be on the ventilator and in ICU.

Let’s get right into it. Rupa, I want to say first, thank you for reaching out and I’m very sorry to hear what you and your family are going through. This is one of the most frightening situations any family can face. I’m going to do my best to give you clear, direct, straightforward, clinically grounded advice and information so you can understand what is happening, so you can ask the right questions and advocate effectively for your mom.

And for every family watching or reading this, if your loved one is in a similar situation, everything I say here applies to you as well. Please watch to the end, because I’m going to tell you exactly how we can help you and other families who have loved ones in intensive care.

And just an important note, everything I share here is general clinical education. It is not a substitute for individualized medical advice. Every patient is different. Please use this information to ask better questions and advocate harder for your loved one.

What Does Multiple Organ Failure After Bypass Surgery Really Mean? 

Multiple organ failure, also called multi-organ dysfunction syndrome or MODS, is exactly what the name suggests. More than one vital organ system in the body is failing or severely impaired at the same time. In Rupa’s mom’s case, we already know at least three organ systems are involved.

Number one, the heart. Was already severely impaired before surgery—ejection fraction of only 20 to 30%. Then Rupa’s mom suffered a cardiac arrest after surgery.

The kidneys. Renal failure developed within two days of surgery, and this often happens after cardiac surgery. It happens from the kidneys not getting enough blood perfusion, especially with low blood pressure. It happens quite frequently after cardiac surgery.

Next, the respiratory system. She’s on a ventilator, meaning her lungs cannot sustain adequate breathing independently. Possibly the immune and circulatory system, fever and fluctuating blood pressure suggest infection, also known as sepsis, or ongoing systemic inflammatory response.

Multi-organ failure after cardiac bypass surgery is a recognized and serious complication. It is more likely when the heart’s function before surgery is significantly reduced and an ejection fraction of 20 to 30%—normally it’s 55 to 70%—means Rupa’s mom went into surgery with a heart that was already under severe strain. Ejection fraction basically refers to the contractility or pump function of the heart, and if it’s only 20 to 30%, that’s not great.

The cardiac arrest after surgery is particularly significant. Even a brief cardiac arrest, even one that is reversed within minutes, can cause a period of reduced blood flow to vital organs. The brain, kidneys, liver, and gut are all highly sensitive to oxygen deprivation. This is likely one of the reasons renal failure developed so quickly.

The fever Rupa mentions is also a critical detail. Fever in this context most commonly points to infection, potentially including ventilator-associated pneumonia, urinary tract infection from an indwelling catheter, central line infection, or surgical site infection. It can also reflect the body’s systemic inflammatory response to major surgery and cardiac arrest, even without active infection. Either way, the ICU team should be actively investigating the source.

The blood pressure drops are another serious sign. Low blood pressure in this context likely means the heart is struggling to maintain adequate cardiac output, or that the blood vessels are dilated due to sepsis, or both. This is why patients in this situation are almost always on vasopressor or inotropic drugs—medications that constrict blood vessels and increase cardiac function and help maintain perfusion pressure to vital organs.

Why Cardiac Arrest, Renal Failure, Fever, and Low Blood Pressure Happen Together

It can feel overwhelming when a family is told that multiple systems are failing simultaneously. The important thing to understand is that these complications are interconnected. They are not independent bad luck events. They form a clinical cascade that is well understood in critical care medicine.

Here is how it typically unfolds in a case like Rupa’s mom.

Step one: severely reduced heart function before surgery. An ejection fraction of 20 to 30% means the heart was only pumping a fraction of the blood it should with each beat. The body’s organs, especially the kidneys, were already receiving below-normal blood flow before surgery even began.

Step two: the stress of major cardiac surgery. Bypass surgery, also known as coronary artery bypass grafting or CABG, is a major operation. The patient is placed on cardiopulmonary bypass, a heart-lung machine, during the procedure, taking over the function of the heart and the lungs because they are out of action. This exposes the blood to artificial surfaces, triggering an inflammatory response and temporarily disrupting normal circulation. Even in healthy patients, this carries risk. In a patient with severely reduced heart function, the risk is substantially higher.

Step three, cardiac arrest post-operatively, or after surgery. A cardiac arrest after surgery, even a brief one that is successfully reversed, causes a sudden and complete drop in blood flow to every organ in the body. The kidneys, which require continuous blood flow to filter waste, are extremely sensitive to this. Acute tubular necrosis, the most common form of post-cardiac arrest renal failure, can occur after just minutes of inadequate perfusion.

Step four, systemic inflammatory response and potential sepsis. Major surgery, cardiac arrest, and renal failure each independently trigger the body’s inflammatory response. When these happen together, the result is often a state called systemic inflammatory response syndrome, also known as SIRS, or if infection is present, sepsis. This is what drives the fever and the blood pressure instability. Sepsis is one of the leading causes of multiple organ failure in ICU patients worldwide.

Step five, ventilator dependence. When the heart is struggling and the body is fighting systemic inflammation, the respiratory muscles cannot sustain adequate breathing on their own. The ventilator is doing the work of breathing, ensuring adequate oxygen delivery and removal of carbon dioxide while the body attempts to recover.

Key Point:

These complications did not happen because something went wrong with the surgery in isolation. They are the result of a severely compromised heart, a major surgical stress, and a post-operative cardiac arrest interacting in a patient who had little physiological reserve. The ICU team is fighting on multiple fronts simultaneously.

Treatment Options for Rupa’s Mom in ICU

When a patient is in multiple organ failure following cardiac surgery, the ICU team’s approach is to aggressively support each failing organ system while treating the underlying causes. Here are the key treatment strategies that should be in place or are actively considered for Rupa’s mom.

Number one, mechanical ventilation and lung protective strategies:

The ventilator is keeping Rupa’s mom alive by ensuring she receives adequate oxygen and her carbon dioxide is cleared. The ICU team should be using lung protective ventilation settings—specifically low tidal volumes, around 6 milliliters per kilogram of ideal body weight—and appropriate levels of PEEP (positive end-expiratory pressure) to keep the alveoli open at the end of expiration and prevent ventilator induced lung injury.

As Rupa’s mom’s condition stabilizes, the team should begin daily spontaneous breathing trials to assess readiness for weaning.

Number two, hemodynamic support, managing blood pressure and cardiac output:

Rupa’s mom is almost certainly on vasopressors and inotropes—drugs like norepinephrine, noradrenaline, adrenaline, epinephrine, vasopressin, dobutamine, dopamine, milrinone—to keep her blood pressure at levels that support organ perfusion. The target mean arterial blood pressure, also known as MAP, in septic shock is generally above 65 millimeters of mercury.

The ICU team should be using invasive monitoring—an arterial line and likely a central venous catheter, as well as potentially a Swan-Ganz catheter or PiCCO (Pulse index Continuous Cardiac Output) to guide this management.

If her cardiac output remains severely impaired, the team may also be considering or already using more advanced cardiac support, including an intra-aortic balloon pump, also known as IABP—a device inserted into the aorta that reduces the workload of the heart—or an Impella or ECMO machine—extracorporeal membrane oxygenation, more advanced mechanical circulatory support for patients whose hearts cannot maintain adequate output despite maximum drug therapy.

Number three, renal replacement therapy:

In Rupa’s mom’s case, the kidneys are no longer filtering waste products adequately, which is common in post-cardiac arrest acute kidney injury. She may need continuous renal replacement therapy, also known as CRRT, or intermittent hemodialysis.

CRRT is the preferred modality in hemodynamically unstable ICU patients because it is gentler on blood pressure than standard dialysis. Importantly, renal failure after cardiac arrest and cardiac surgery is often reversible. The kidneys can recover, sometimes weeks to months later, if the patient survives.

Number four, infection management and sepsis treatment:

Given the fever and blood pressure instability, the team should have already taken blood cultures, sputum cultures, urine cultures, and possibly wound swabs and should be treating with broad-spectrum intravenous antibiotics. The antibiotic choice should then be narrowed based on culture results. If septic shock is confirmed, the Surviving Sepsis Campaign guidelines recommend antibiotics within one hour of recognition.

Number five, nutrition and metabolic support:

Critically ill patients, especially those on ventilators, require nutritional support. This is typically delivered via a nasogastric or nasojejunal tube—enteral nutrition whenever the gut is functioning—or via intravenous total parenteral nutrition, also known as TPN, if enteral feeding is not tolerated.

Tight blood glucose control is also important. Stress hyperglycemia is common in ICU patients and worsens outcomes if not managed.

Number six, sedation and pain management:

Ventilated patients require sedation and analgesia to keep them comfortable and prevent them from fighting the ventilator. The current standard of care favors lighter sedation, targeting Richmond Agitation Sedation Scale score of -1 to -2, and daily sedation holds to assess neurological status and readiness for breathing trials.

Number seven, prevention of secondary complications:

In a prolonged ICU admission, the team should also be actively preventing common secondary complications, including deep vein thrombosis (DVT), pressure injuries, ventilator-associated pneumonia (VAP), and ICU-acquired weakness. Early physiotherapy, regular position changes, and oral hygiene protocols all play a role.

So, What Should You Be Asking the ICU Team?

What specific organ systems are failing right now, and what is the trend? Are they stabilizing, improving or deteriorating?

What vasopressors is she on and are the doses going up or down?

Has a source of infection been identified?

Is renal replacement therapy being used or considered?

What’s the plan for weaning the ventilator?

What Are the Chances of Recovery?

Rupa asked directly, what are her mom’s chances of recovery? And I want to give you a direct, straightforward answer because I believe families deserve straightforward answers rather than false reassurances or needless pessimism.

The straightforward answer is it depends on factors that I cannot know from the information provided and that even the ICU team can only estimate, not predict with certainty.

What we do know from the medical literature is that multiple organ failure in the ICU is associated with significant mortality. The risk increases with the number of organs failing simultaneously and with the severity of dysfunction in each organ. The APACHE 2 and SOFA scoring systems are commonly used in ICUs to estimate severity of illness and mortality risk. The ICU team can tell you what Rupa’s mom’s score is and what it implies.

However, this is critically important. These are population level statistics. Individual patients surprise their ICU teams in both directions. I’ve seen patients with very high predicted mortality scores survive and go home. And I have also seen patients who appear to be stabilizing deteriorate rapidly.

Factors at work in Rupa’s mom’s favor:

She’s only 68 years old, not elderly by any stretch of the imagination, and age alone is not a death sentence in ICU. Her cardiac arrest was reversed within minutes. Prolonged cardiac arrest carries a far worse prognosis. Multi-organ failure after cardiac surgery, while serious, is a recognized and treatable condition. ICU teams manage this regularly. Renal failure in this context is often reversible if the patient survives.

Factors that represent serious concern:

Post-operative ejection fraction of 20 to 30%. This means she had very limited physiological reserves going into surgery. Multiple organ systems failing simultaneously, not just one. Ongoing fever and blood pressure instability—these suggest the underlying cause, infection or systemic inflammation, has not yet been controlled. Ventilator dependence. The longer a patient requires mechanical ventilation, the greater the risk of ventilator associated complications.

As for how long she will need to be on the ventilator and in ICU, this is genuinely impossible to predict at this stage. In patients who do recover from multi-organ failure after cardiac surgery, ICU stays of 2 to 4 weeks or longer are common. Some patients require weeks of ventilation before they can be weaned. This is why families need to be prepared for a long road, even when recovery is ultimately possible.

Why You Must Get Access to All Medical Records

Rupa and every family reading or watching this, I cannot stress this enough: you need to get access to all of your mom’s medical records. Every single one. Every single page. This is not optional. This is one of the most critical things you can do right now.

Here’s why this matters so much. The medical records tell you exactly what is happening to your loved one, not just the summary the ICU team chooses to share in a brief family meeting, but the full picture. Every blood test, every result, every imaging report, every medication, every ventilator setting, every nursing note, every doctor note.

The records allow you or a consultant like myself to identify whether best practice guidelines are being followed, whether anything has been missed, and whether there are treatment options that have not been considered. The records give you a basis for asking specific informed questions rather than accepting vague reassurances.

If you ever need a second opinion from another ICU specialist, from a telemedicine service, or from us at intensivecarehotline.com, you cannot do this effectively without access to all medical records. In the worst case, if a complaint or legal matters ever arise, the records are the foundation of any investigation.

In most countries, you have the legal right to access the medical records of a family member if you are their next of kin or have been granted power of attorney for health decisions. The hospital’s patient services or medical records department can tell you the process. Do not be put off if the first person you ask seems reluctant. Be persistent and ask to speak to the patient liaison officer or hospital administration if needed.

Do not wait until your mom is discharged to request the medical records. Request them right now, regularly, so you can follow her progress in real time.

Here’s your action step:

Contact the ICU team, hospital’s medical records department, patient services team today and request access to your mom’s complete medical records, including all test results, imaging reports, progress notes, medication charts, everything. Leave no stone unturned. You have a right to this information.

How Can We Help at Intensivecarehotline.com Right Now?

Here at intensivecarehotline.com, we specialize in helping families exactly like Rupa’s—families who are facing a medical crisis, who are being given limited or confusing information, and who need someone in their corner with genuine ICU expertise.

Here’s what we can do for you:

Review all medical records and explain them to you in plain language

Identify whether the ICU team is following best practice guidelines for your loved one’s specific conditions

Either ask the right questions to the ICU team or help you formulate the right questions to ask the ICU team and coach you on how to ask them effectively, or we ask them effectively on your behalf

Conduct a three-way consulting call with you and the ICU team, with your permission, to advocate on your loved one’s behalf

Question clinical decisions and push for treatment options that may not have been discussed

Remind the ICU teams of your rights

Provide a second opinion on the overall management plan

Support you through decisions about goals of care, withdrawal of treatment, and end of life planning if it comes to that

You can also join our membership at intensivecaresupport.org, where we have a membership for families of critically ill patients in intensive care. But reach out to us today for a consulting call at intensivecarehotline.com.

Intensive Care at Home—The Long-Term Alternative to Long-Term ICU

Now, Rupa, I want to talk about something that most families in your situation never hear about from the ICU team, and that is the option of specialist home-based intensive care nursing as an alternative to a long-term stay in ICU.

I’m also the founder and director of Intensive Care at Home. You can get more information at intensivecareathome.com.

We are a third-party accredited specialist home nursing provider for ventilator-dependent adults and children with tracheostomies, without tracheostomies, with ventilation, tracheostomy without ventilation—anyone that would otherwise be long-term in ICU.

And here is what I want Rupa and every family in this situation to understand. If Rupa’s mom cannot be weaned off the ventilator, and some patients in her situation cannot, she doesn’t have to remain in an ICU or acute hospital ward indefinitely. There’s a viable, clinically safe, and often superior alternative—specialist home-based intensive care nursing. Ventilation care delivered by critical care registered nurses 24 hours a day.

At Intensive Care at Home, we provide exactly that. We care for patients who:

Require long-term invasive mechanical ventilation with a tracheostomy

Require long-term non-invasive ventilation with a mask or a mouthpiece, for adults and for children

Have a tracheostomy but have been weaned from the ventilator and need ongoing tracheostomy and airway management for adults and for children

Require complex clinical care that cannot be safely provided by standard community nurses or support workers

Are in ICU and are clinically ready for discharge but have nowhere safe to go but Intensive Care at Home

Need palliative care at home with full ventilation and airway support maintained for quality of life with Intensive Care at Home

Our Intensive Care at Home model of care is built around one principle: that people who require life sustaining technology deserve to live at home with their families, not in an institution.

The clinical evidence strongly supports what we do with Intensive Care at Home. Patients cared for at home with adequate specialist nursing support have fewer hospital acquired infections, better quality of life, and equivalent or better clinical outcomes compared with long-term institutional care.

We hold ISO 9001:2015 accreditation for Intensive Care at Home. And all of our Intensive Care at Home critical care registered nursing team have expertise to manage ventilation, tracheostomy, feeding tubes, intravenous medications, the full spectrum of complex clinical care in your home around the clock.

Find out more at intensivecareathome.com.

It’s too early in Rupa’s mom’s admission to plan for homecare. Right now, the focus must be on survival and stabilization. But if she does survive this acute phase and remains ventilator dependent, this option should absolutely be on the table. Many families are never told it exists. Now you know.

Let’s Summarize and Look at Next Steps

Let me summarize everything we have covered for Rupa and for every family in a similar situation.

Rupa, your mom is in multi-organ failure following bypass surgery for severely reduced heart function, complicated by a post-operative cardiac arrest and acute renal failure. The fever and blood pressure instability suggests ongoing systemic inflammation or infection, potentially sepsis. She’s on a ventilator because her respiratory system cannot sustain breathing independently in this context.

What the ICU team should be doing:

Aggressive multi-organ support, ventilation support with lung protective strategy, hemodynamic support with vasopressors, inotropes, and possibly mechanical cardiac assist devices, ECMO, intra-aortic balloon pump, renal replacement therapy, dialysis if indicated, broad spectrum antibiotics guided by cultures, nutritional support, and prevention of secondary infections.

What you need to do right now:

Request all medical records immediately. Every test, every note, every result. Leave no stone unturned.

Ask the ICU team for a detailed update: which organs are failing, what the trend is, what treatments are in place, and what the plan is.

Ask specifically about infection. Has a source been identified? What antibiotics are being used? What do the cultures show?

Ask about cardiac support. Is the heart functioning? Is it recovering? Is mechanical support being considered?

Ask about renal replacement therapy. Is it being used? What is the urine output?

Get expert help. Contact intensivecarehotline.com right now so we can support you through this.

And if long-term ICU is needed, come to us at Intensive Care at Home. Find more information at www.intensivecareathome.com.

Rupa, I’m thinking of you and your mom right now. This is one of the hardest situations a family can face. Please reach out now. You don’t have to navigate this alone. We are here to help.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over five years in intensive care. And I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. And I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights, and you can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section, where we have done client interviews.  And because our advice is absolutely life-changing, right?

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 that’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always. And that’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

And that’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. And I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. And when I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.  I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care, so, if, in case you have unanswered questions, if you need closure or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com. If you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team 24 hours a day in the membership area and via email, and we answer all questions intensive care-related. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. And all of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

And all of that you get at intensivecarehotline.com. Call us on one of the numbers at the top of our website or simply send us an email to support at intensivecarehotline.com with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have from this video.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.