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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So today, I want to actually focus on one of our members and also showcase what our membership does for our clients so that you can see what you get in case you’re wondering what the membership exactly entails. Today I want to give you a very tangible example of that.

I simply want to read out an email from one of our members and also how we answered the question as much as you see me here for the face of intensivecarehotline.com. We have a team working in the background. So, thank you to my team, my wonderful team, that’s doing all and some of the heavy lifting in the background when engaging with clients, one-to-one, especially when it comes to the membership whilst I do all the phone consulting, some of the members are actually managed by our team.

Quite frankly, we are employing decades of intensive care experience on our team so that our clients and our members will get the best value for their membership, and you can get a second opinion in real time.

So, without further ado, let me read out an email from one of our clients who has their elderly father in intensive care. Obviously, we enter into a dialogue with our clients, and guide them step-by-step on what they should be looking for, what questions they should be asking. If I don’t talk to the intensive care team directly, our clients can reach out via email.

So, let’s read out the email. Our member writes,

“They have managed to finally stop the unexplained fevers and the leukocytosis by giving the doxycycline every day indefinitely as a suppressive treatment. They think they’re treating chronic osteomyelitis, but they aren’t sure.

They started the heart failure medications as well and it was going fine for about three days before my dad’s blood pressure started to drop about four days ago. They don’t know why his blood pressure dropped and he has needed to stop the heart failure medications and started on midodrine. They did the standard septic work up and ultrasound of his lungs and heart and haven’t found any reason as to why his blood pressure dropped.

They thought at first it might be hemorrhagic shock, but two units of blood did not impact on his blood pressure at all. My dad has chronic anemia and anemia simply means a lack of red blood cells.

I asked them if it was because of all the new heart failure (Carvedilol, Entresto, and Jardiance). They repeatedly told me, “No”, until yesterday, when they finally said that it could be a possibility.”

So, you can see here that it’s critically important just with that interjection from our member, that it’s so critically important that you know what questions to ask. The member continues.

“He’s in the ICU now but being transferred back to the step-down unit. He’s still on the midodrine and because of all the fluids they gave to try to increase his blood pressure, he’s having pleural effusions which are increasing his secretions and his oxygen needs have been fluctuating, but currently are at 30% FiO2 on the tracheostomy collar, not ever needing to go back on the ventilator.

Do you happen to know what the standard plan is for beginning GDMT which stands for Guideline Directed Medical Therapy for heart failure treatment? They started that on Carvedilol 6.5 mg. The next day started Entresto. On the third day, started Jardiance.

I read on the internet that some of these medications don’t reach their full potency until 4 – 7 days, which coincides with when his blood pressure inexplicably dropped, and the half-lives of these medications can be weeks so it can be some time before he can get off midodrine, is what I’m concluding from my research.

The doctors just continue to say, “I don’t know, we’ll see.” Useless comments that don’t provide any explanations, insights, and definitely not comfort.  They aren’t giving Lasix at the moment because that drops the blood pressure. They haven’t given IV vasopressors or inotropes, just the midodrine.

Thank you so much for your help.”

Here is our response to our member, to the email.

“Thank you for your update.

It is good to note that they found the right medication to control his fever and high white cell count/leukocytosis. This is one step forward.

Regarding your dad’s heart failure medications, the initiation of multidrug therapy (4 drugs as first step) is the standard or ideal course of action for heart failure. It is started simultaneously in lower doses if it is applicable to the patient. Some patients don’t tolerate these drugs due to their comorbidities and the doctors will start them sequentially just like what they did to your dad. In addition, the drugs may differ in effects according to your dad’s hemodynamic stability, severity of heart failure, nutrition, and other existing diseases/conditions; so, generating specific plans to address his heart failure can be very challenging.

The main goal of therapy is the resolution of signs and symptoms of heart failure. If he had tachycardia, which is a high heart rate, he would be started with Carvedilol or Entresto. If he had significant fluids in the lungs/congestion, he may be started with Jardiance or Aldactone after diuretics or Lasix to relieve his congestion and improve his breathing. Assuming the nurses monitor it accurately, the daily intake and output of your dad is a good indicator if the doctors can still give Lasix to decongest your dad and it also depends on his kidney function tests and vital signs such as blood pressure, heart rate, and oxygen saturation.

I think midodrine is the safety net as of now to prevent hypotension, which is low blood pressure, and worsening of heart failure. The use of erythropoietin (used to make more red blood cells) for anemic patients with heart failure is also not recommended based on studies.

I hope that helps. Please don’t hesitate to email us back should you have any questions.

We are praying for your dad’s health.”

So, that’s just one example how we answer our member’s questions. There have been many ongoing emails with this member. I’ve also had one-to-one consultations with the member on Zoom so this is a long-standing member of ours and I just think it helps everyone watching this who wants to know more about heart failure in intensive care and how it is being treated.

So, I hope that helps you.

If you want to become a member for families of critically ill patients, go to intensivecaresupport.org and have a look at our membership. There, you have access to me and my team, 24 hours a day, in a membership area and via email and we answer all questions intensive care related.

I also offer one-to-one consulting and advocacy over the phone, via Zoom, via WhatsApp, via Skype, whichever medium works best for you. If you’re generally curious to know more about Intensive Care Hotline, 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].

We’re also providing medical record reviews in real time where we can give you a second opinion in real time by reviewing the medical records. As I said, I do also talk to doctors and nurses directly in intensive care and ask all the questions that you haven’t even considered asking. The biggest challenge for families in intensive care is that they don’t know what they don’t know. We also provide medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence, we can help you with that as well.

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

Thanks for watching.

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

Take care for now.