Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So, we have worked with a client recently that had their mother in intensive care after contracting COVID. She ended up with ARDS or lung failure. ARDS stands for acute respiratory distress syndrome. Also known as lung failure.
Many COVID patients that end up in ICU end up with ARDS. Now she had the “standard treatment” while she was in ICU, which is a prone position, which is basically a patient’s get turned on their tummy head down. They have to be in an induced coma for that, and often also get paralyzed so that they can tolerate the proning.
The purpose of proning therapy for ARDS is basically to drain the lungs of excess fluids to actually have the lungs being able to expand and that is definitely possible when patients are in a prone position. Now there’s no guarantee that this can work, but it has shown to be effective for many patients in intensive care.
Furthermore, they had the Remdesivir antiviral treatment, but that didn’t do much and she ended up with high oxygen requirements. She ended up in a prolonged induced coma. She ended up on inotropes and vasopressors because she was hemodynamically unstable because of the septic picture. Cutting the long story short, she then ended up with a tracheostomy because she couldn’t be weaned off the ventilator and she ended up in LTAC, also known as long-term acute care.
Now, depending on how much research you’ve done, we strictly advise against LTAC or long-term acute care here at Intensive Care Hotline, simply for the reasons that LTACs are designed to save money, but they’re not designed to provide the clinical care necessary for a critically ill patient.
Now, if you think about it, a care episode for a critically ill patient should not be disrupted, and that’s basically what’s happening when someone is going to LTAC. Patients in ICU are the most vulnerable patients and why would you disrupt the care episode by sending them to LTAC? It’s almost unheard of in my mind, it’s a criminal offense to do that.
Anyway, coming back to our client’s situation, the client ended up in LTAC. The LTAC had an ICU attached and the client only after a few days of being in LTAC, after they had the trach or tracheostomy in ICU, deteriorated in LTAC which is often what happens. Just by critically ill patients being transferred to another facility with a new care team increases the risk for deterioration. That’s just the reality. Again, those patients are the most vulnerable patients in a hospital and why would you transfer them to another facility?
So, the client’s family member, the client’s mother then ended up in the ICU that was attached to the LTAC, and there she deteriorated very fast. She was back on a hundred percent of oxygen. The ARDS picture showed again. They didn’t want to prone her anymore. They never offered nitric oxide therapy. They never offered Epoprostenol therapy. They never offered any sildenafil therapy. Sildenafil is also known as Viagra. So, neither the first hospital nor this ICU offered ECMO therapy.
So here is the bottom line. If you don’t do research from day one, when someone is critically ill in intensive care, your chances of having any control over this situation diminish rapidly, very rapidly as a matter of fact.
So by not knowing about alternative therapies, such as ECMO, if prone position doesn’t work, but not knowing about standard therapy for ARDS, such as nitric oxide, potentially Epoprostenol nebulizers potentially Sildenafil, the family didn’t know about this until weeks, many weeks down the line.
And that’s simply because they haven’t done their research from day one. They trusted the intensive care team blindly without doing their own research. And the bottom line is this. You need to take responsibility for your own outcomes, for your own best outcomes for your loved one.
So eventually our client was very unstable in the ICU that was attached to the LTAC. The family wanted to send her back to intensive care where she came from or back to another intensive care unit. But at that stage, it was too late. She was too unstable to be transferred. And eventually, unfortunately, she passed away.
If the family had known about ECMO, about other treatment options from the start, if they had contacted us from the start, we could have helped them, guiding them in the right direction, looking at other hospitals, holding the intensive care team accountable with the second opinion and look at what treatment options would have been available for their loved one.
So I can’t stress enough that, number one, you need to do your own research from day one. Number two, we strictly advice against LTAC. If you can see that on our other case studies why we advise against LTAC very strictly and people need to stay in ICU, or if they can’t be weaned off the ventilator, they can go home with services like Intensive Care at Home, but definitely not LTAC.
So that’s my quick tip for today. Don’t go to LTAC. Do your research from day one. Every day when you don’t do your own research so you’re losing valuable time. And you, not doing your research can quite literally be a deadly outcome because of that.
So that’s my 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 the website, or send me an email to [email protected].
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This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.