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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care. So I’ve got an email from a reader who says, “My mom is in ICU with multi-organ failure with underlying severe acute pancreatitis. She’s ventilated requiring 50% FiO2 support on the ventilator, blood pressure support and dialysis. What are our next steps? What questions should we ask regarding further treatment? Today, she has had a cytosis drained via ultrasound, endoscopy, and fluid drain from a pulmonary edema. 700 mls was drained. She’s only 67 years old”. Thank you so much for this question. Let’s break down what’s happening.

Unfortunately, many patients in ICU that end up with pancreatitis can go into a multi-organ failure, but I’ll come back to that in a minute. Let’s just carry on with that email where our reader says she’s ventilated requiring FiO2 (fraction of inspired oxygen) support 50%. So, she’s on the ventilator on 50% oxygen. Room air, the air that you and I are breathing is 21%. So that’s a fair amount of support, but it’s only one of many numbers on the ventilator that need to be considered. I would be curious to know what ventilation settings is your mom on? What are her arterial blood gases?

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. This is another very typical example that the information that this reader is sending us is great, but it’s still only probably about 30% of the information we would need to make an accurate assessment. But let’s carry on.

She’s also saying that she’s on blood pressure support, which means most likely she’s on inotropes or vasopressors for low blood pressure, which is also considered life support by the way. So, basically what’s happening, part of the multi-organ failure and pancreatitis is because of the infection. This lady might be in septic shock, her blood pressure might have dropped because of that, and therefore, she needs inotropes or vasopressors through a central line to keep her blood pressure compatible with life.

Now, she’s also on dialysis, which is another form of life support. So at the moment we can identify with multi-organ failure. She’s on three levels of life support. A) is the mechanical ventilator, B) is the inotropes or vasopressors for the low blood pressure and C) is dialysis for kidney failure. What are our next steps? What questions should we ask regarding further treatment?

So often, when someone has a pancreatitis, one of the important things is to keep someone nil by mouth. So not giving anything orally, which is not an option on a ventilator with a breathing tube anyway, but also not to give any nasogastric tube feeds. So one of the ways to manage that and maintain nutrition is TPN, also known as Total Parenteral Nutrition or also known as intravenous nutrition. So you should be asking for that.

Number 2, you should be finding out what your mother’s blood results are. For example, does she have a high white cell count to further confirm that she has a septic shock or that she has an infection? What’s her temperature like? What are her amylase and lipase levels? Because they are the pancreas markers, they’re probably elevated because of the pancreatitis. What’s her gallbladder doing? Sometimes the gallbladder can be affected as well in pancreatitis. So is her bilirubin level high or are the bilirubin levels high? Next, what do they suspect is happening with the pancreas in the long run? Do they think they need to remove it once the infection has reduced? Also with pancreatitis, often blood sugar levels are all over the place because insulin is being produced by the pancreas. So with the pancreas being infected, insulin may not be produced as well as normally. So therefore your mom might show signs of diabetes in the interim.

Now, also with the dialysis, obviously she’s in kidney failure. What are her kidney markers? Are the kidney markers coming down? Is she starting to make urine? How long do they think she will need the dialysis for? Those are also very important questions to ask.

And again, with her being in multi-organ failure, is she in an induced coma? Is she sedated or is she awake, potentially. Does she need a tracheostomy as a next step? Those are all important questions to ask. You also haven’t shared how long your mom has been in ICU? Is this a new thing? Has she been in ICU for two weeks already? If she’s been in ICU for 10 to 14 days, ventilator or tracheostomy might be the next natural step.

Now you also saying today, she has had a cytosis drained via ultrasound, endoscopy, and fluid drain from a pulmonary edema. 700 mls was drained. She’s 67 years old, so there’s lots going on there. Well, I don’t know what happened with the cyst, but that’s probably part of the abdominal issues that are going on with the pancreatitis. And then fluid drain from a pulmonary edema, 700 mls was drained. She probably might have a chest drain in her lungs to drain more fluids.

So there’s a lot going on there. And you haven’t shared how long your mom has been in ICU, but you got to look at the positives. Your mom is alive at the moment. Yes, she’s very, very sick, but every day she lives, hopefully she can recover. And keep asking the questions that are just highlighted to you.

I want to keep the video reasonably short. And there are many more questions you should be asking. For example, what sedatives is she on? Is she on opiates such as morphine, fentanyl. Again, blood results, arterial blood gas results, ventilator settings, the complete ventilator settings, would be very interesting to find out. Have they done an abdominal ultrasound? And I’m sure they would have by now. Have they done an ultrasound of the heart because she’s on inotropes and vasopressors? Have they done kidney ultrasound because she’s in kidney failure? So those are all questions to ask. What are the next steps? When can they wake your mom up, and get her out of the coma?

So that is my quick 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 our website or simply send us an email to [email protected].

Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There you have access to me and my team 24 hours a day, and we answer all questions intensive care related.

Also, if you need a medical record review for your loved one in Intensive care, go and contact us as well. We review medical records for families, for patients in intensive care while they are in ICU, but we also review them after intensive care, but we strongly recommend to have them reviewed in real time while your loved one is in intensive care.

Now, like the video, subscribe to my YouTube channel for regular updates for families in intensive care. Share the video with anyone that can benefit from it. Click the notification bell and comment below what questions and insights you have from this video or what other topics you want me to talk about.

Thank you so much for watching.

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

Take care.