Hi, it’s Patrik Hutzel from intensivecarehotline.com where we instantly improve the lives for families of critically ill patients in intensive care so that you can make informed decisions, get peace of mind, real control, power, and influence fast.
So today I want to answer another question from one of my clients and readers and Freddy has written me an email with his father’s situation. So here is what Freddy says. My father was taken to hospital on Friday afternoon because his breathing had gotten progressively more raspy beginning on Wednesday evening. They suctioned him out before leaving the house and they didn’t transport him with lights and sirens, so non-urgent transport.
Upon arrival at the emergency room, they placed him on a ventilator to help him breathe and then took him to ICU. At some point that day, his core temperature was 104.4 which is probably around 39 or 40 degrees Celsius and his sugar was 425. His temperature had been fluctuating at home between 97 to 100.6 Fahrenheit the previous day, that’s would be around 37 to 38 Celcius.
They said he had an infection and they began antibiotic treatment right away and they ran all the tests. All results thus far have been negative so they have not yet determined the source of the infection. He’s mostly breathing on his own, but sometimes his breathing rate is too fast and sometimes he needs assistance.
His temperature was at 99 Fahrenheit, which is again around 37 some time yesterday, but not overnight. His sugar was 200 overnight and he continued to breathe mostly on his own. He opened his eyes multiple times for me last night and for one of the female nurses, but not for the male nurses. At home, all of his cares are provided by females.
When I asked him to do things or spoke to him, he responded to me. He has only been on the ventilator for three days and my brother was on one for four days a couple of months ago with no concern for long term damage, that they are stating is their concern with my dad who’s 85 by the way.
My brother is obviously much younger than my dad, thus would expectedly half a quicker response rate than someone older. I feel my dad needs more time to heal. I do not feel this added time would be harmful to him at all. I feel his response to my interaction with him is an indication that he’s still fighting and we should give him a chance. Am I wrong?
So Freddy, thank you so much for your email and for asking the questions you’re asking. So basically your dad needs time. Anybody with an infection being on a ventilator, critically ill ventilation, breathing tube, induced coma in intensive care needs time. That’s why they’re there.
Intensive care is a marathon, not a sprint. For somebody to come out of a situation like that takes time, especially if your dad is 85 but he needs to be given a chance. So what needs to happen and going through it step by step, you’re saying they’ve run the tests, so no results have come back positive, but there must be an infection somewhere.
If it’s a bacterial infection, they will hopefully find the bacteria and then can start the right antibiotics. If they’re not finding something, it’s probably a viral infection. What they need to check is sputum sample, blood sample and urine sample to take for any infections. And again, once they’ve isolated the infection, start the right antibiotics.
In the meantime, they can start broadband antibiotics to have a broad cover and see how you go as long as your dad is having a temperature, they probably haven’t isolated the infection and they’re not treating the right infection yet. Other things you need to look for is blood results such as CRP, white cell count. That’ll also give you an indication whether your dad has an infection or not.
If your dad’s been on the ventilator now for three or four days in an induced coma, it’s not a long time. It’s not a long time at all. You know, once they are treating the right infection is a very good chance your dad will get more awake at the same time, whilst he’s on a breathing tube and in an induced coma, is probably on sedation such as propofol or midazolam also known as versed and he will be on opioids or painkillers such as fentanyl or morphine, so that he can tolerate the breathing tube and the ventilator.
People do respond in an induced coma, even though it’s only a little bit, but bear in mind, the sedation and the pain medication will keep him asleep. So is probably, you know, best way to describe it, sort of in a twilight zone or in a deep sleep even. So, yes, getting responses is not uncommon at all, but at the same time, if he’s in an induced coma, you really need to wait until they’re waking him up and see what his responses are.
Then at the moment, I’m almost bound to say yes, it’s good that he is responding, but it’s almost not relevant because he needs to recover from that critical illness in the first place and then worry about him responding or not, because everything will be so much easier if they’re treating the right infection and then he can wake up from there.
Challenges with this situation are that, if they’re not treating the right infection, hopefully it’s not developing a sepsis because that would be sort of the next worst-case scenario if he would develop a sepsis out of that infection, because then it would be really life-threatening.
Your dad could crash with high heart rate, low blood pressure. He probably would end up on inotropes or vasopressors for low blood pressure. You better find out anyways, if he is on inotropes or vasopressors, which is another form of life support for a low blood pressure, which often again goes hand in hand with an infection or a sepsis.
Hopefully, if they’re starting to treat the right infection, hopefully his temperature will come down as well. And then again, you will see that your dad will, get more and more awake. Other challenges you might come across once your dad is waking up. He may not come off the ventilator straight away because he might be too weak.
But if that’s the case, you definitely should get in touch with me here at intensivecarehotline.com either sent me an email to [email protected] or even better to call me on one of the numbers on the top of our website.
You also mentioned that your dad had a triple bypass in 2002 but besides a few TIAs and the brain aneurysm around 2004 he hasn’t had any major issues in regards to his heart. That’s great. Just make sure he’s not in any atrial fibrillation or AF. You know, he had an ECG last month, you were saying, and it was found to be unchanged. But you know, when people are critically ill, sometimes they do go into atrial fibrillation, electrolytes can change and that sometimes triggers atrial fibrillation. So just keep an eye on that.
You’re also saying Freddy, that your gut feeling is that he’s still fighting and is not yet done, that you spoke to a friend who’s a respiratory therapist and she spoke to the doctor based on his respiratory numbers. At that time, she would feel comfortable taking her mother off the ventilator. So we’re going to attempt that tomorrow at 11 and if he doesn’t do well, the doctor has agreed to put him back on. You asked repeatedly to get a second opinion, but he really seemed to have a problem with that and it never happened. The best I got was my friend who gave her opinion over the phone.
So it’s great that you’re talking to a friend, but that doesn’t replace a professional consultant advocate like myself who can talk to the doctors on a clinical level because you know, I’ve worked in intensive care for over 20 years and I know intensive care inside out. So, you know, you just got to get me on the phone with a doctor to get a second opinion.
But for now, let’s get your dad off the ventilator tomorrow if that can be achievable. And if he doesn’t do well, put your dad back on at the same time, I would not rush to take out the breathing tube because when you take out the breathing tube, ideally you don’t want to put it back in sort of a limited window where you can take out the breathing tube safely and you wanted to use that time very, very carefully because it would be almost traumatic for your dad to get off the ventilator and then be put back on it. It wouldn’t be the right approach. You want to choose the right time frame to right time when to take your dad off the ventilator and they need to work towards that.
The other issue that I quickly want to bring up is your dad’s high blood sugar. I would imagine he’s diabetic, by the sounds of things. Again, make sure they are giving him an insulin infusion and that they’re titrating the insulin infusion according to his blood sugars, so that can be managed safely just as a side note.
So I hope that answers your question, Freddy. I hope it’s all going well. As I said, if any, complications or any further setbacks, please give me a call on one of the numbers on the top of the website at intensivecarehotline.com or send me an email to [email protected]
This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days. Take care for now.