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 of families of critically ill patients in intensive care so that you can make informed decisions and have peace of mind, control, power, and influence, even if you’re not a doctor or a nurse in intensive care.

Before I read out Amy’s question today, Amy is one of our members. You might wonder what makes me qualified to answer questions for families 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. I’ve been consulting and advocating for families in intensive care here at intensivecarehotline.com since 2013. I can confidently say that we have saved many lives for our clients in intensive care and you can verify that in our testimonial  and podcast sections, where we have plenty of testimonials and podcast interviews.

So, let’s read out Amy’s question.  Amy says:

“Hi Patrik, 

An update about my mother, about whom we had a consultation on Thursday afternoon with the ‘mad doctor,’ a pulmonologist who burst into the room.  Mom was on 50% oxygen and 50 L of high-flow oxygen. She was in a regular room with a normal oxygen cannula set at 4 L and was staying at 95–98%. She was receiving no more intravenous fluids. 

She was discharged last night back to her nursing home. We are delighted. However, there is something in me that is a bit suspicious.  She has done pretty well this past day, but her respiratory rate is still quite high, though she doesn’t seem in distress at all, and her oxygen has ranged from 90 to 98% today. It was sagging down around 90% when I left, which bothered me. 

I still would like to pursue whether there’s something else to do about the protein. I have been thinking about what you said about calling on a gastroenterologist, but also her GP told me that her inability to take in more protein may be an end-of-life thing.  Please advise me about this. Mom is talking, alert, and feisty, so we’re happy to have her back and to be out of the hospital and out of ICU. I just thought you might like to know. 

Have a lovely weekend. 

From Amy.”

Amy, I want to tell you that your feelings and thoughts matter because, in today’s video, I’m going to walk you through what the clinical picture may be telling us, what questions you should be asking, and what options may be available for your mother’s ongoing care.

If you have a loved one who has been in ICU or is currently in a nursing home with complex medical needs, this video is for you as well, so stay with me.

Your concerns about your mom are completely understandable. Your mom is alert, talking, and feisty. Those are positive signs. Let me explain why.

Let’s start with the oxygen levels.

A saturation of 90% is not necessarily an immediate emergency in every patient, but it is a level that requires clinical attention, particularly when accompanied by an elevated respiratory rate. On the oxygen–haemoglobin dissociation curve, 90% corresponds approximately to a partial pressure of oxygen in arterial blood (PaO?) of about 60 millimetres of mercury.  That is around the lower limit of what we generally consider an acceptable level of oxygenation in many clinical situations.

The bigger concern is not one reading. It is the trend, and the fact that her respiratory rate is still elevated tells me that her body may still be working harder than it should to maintain oxygenation.

Even when a patient doesn’t look distressed, the physiology may still be under significant stress.  An elevated respiratory rate in a nursing home patient should always prompt the question: What is driving this?  It could be fluid in the lungs. It could be an ongoing infection. It could be a blood clot. It could be heart failure. And this is what I really want to focus on: it could be related to the low protein.

Amy, I know you’ve been thinking about the protein issue, and I’m glad you brought it up because this is important.  Low albumin, a major protein in the blood, can contribute to fluid accumulation in tissues and may complicate the management of patients in nursing homes, hospitals, and intensive care units.

Here’s the mechanism.

Albumin is the main protein that helps maintain the oncotic pressure that keeps fluid inside blood vessels. When albumin drops, fluid can move out of the bloodstream into the tissues, potentially contributing to swelling and, in some circumstances, fluid accumulation in the lungs.  That can cause pulmonary oedema, which means fluid in the lungs.  And what does fluid in the lungs do? It makes breathing harder, can lower oxygen saturation, and can raise the respiratory rate.

So, when I hear that Amy’s mom has a high respiratory rate, oxygen saturation dipping to 90%, and low protein, those things may be connected. However, other causes need to be assessed by her treating medical team.

Now, is low protein an end-of-life thing?  It can occur in people who are approaching the end of life, but it can also result from other conditions that may be treatable. Before accepting that conclusion, you need to know whether the appropriate questions have been asked.  Has a gastroenterologist been consulted?  Has a dietitian reviewed her nutritional intake?  Have nutritional supplements or tube feeding been considered, if appropriate?  Has anyone looked at why she cannot absorb enough protein, whether that is related to gut motility, malabsorption, or something else?  These are questions that need answers before anyone uses the phrase “End of Life.”

Next, Amy, this is something I tell every family I work with in these situations, and I mean it every single time.  You need access to all of your mom’s medical records.

That means all the blood results, all the imaging, the chest X-rays, the computed tomography (CT) scans, all the doctor’s reports, all the nursing reports, the discharge summary, the specialist letters, the ventilation charts, the vital-sign charts, and the laboratory results.  Leave no stone unturned. Also request the fluid balance chart, for example, because fluid in the lungs could also be associated with fluid overload.

Why?  Because the information in those records may contain details that were never communicated to you at the bedside, and without those medical records, it can be difficult to advocate effectively.

In countries like Australia, the United States, Canada, the United Kingdom, and India, access to medical records is governed by applicable laws and procedures. Ask the hospital for your loved one’s records, including records from the ICU.  Request them from the nursing home if that’s where your mom has returned. Do it now rather than waiting until next week.  Then get those records in front of someone who can explain what they mean in plain language. That’s exactly where we can help you.

At intensivecarehotline.com, when you book a consulting call with me or my team, we go through the medical records with you. We explain what the clinical picture may mean, identify questions you may not have considered asking, and help you prepare to advocate with the ICU team, the pulmonologist, the general practitioner (GP), and the nursing home.  You do not have to navigate this alone. Call one of the numbers at the top of our website, intensivecarehotline.com, book a consulting call through the appointment button, or send an email to [email protected].

And now let me tell you something that might surprise you.  Intensive care nursing does not have to happen in a hospital or in ICU alone.  At intensivecareathome.com, we can provide specialist 24-hour critical care nursing for adults and children in their homes and, where appropriate and feasible, in nursing homes too.  We can assess whether support may be suitable for a patient who needs non-invasive ventilation, such as bilevel positive airway pressure (BiPAP) or continuous positive airway pressure (CPAP), high-flow oxygen, close respiratory monitoring, airway management, or tracheostomy care.  Our critical care registered nurses can provide care 24 hours a day, depending on the service arrangements and the patient’s needs.

Currently, Intensive Care at Home operates across Australia.

Even if you’re in the United States, Canada, the United Kingdom, India, or another country and you’re interested in intensive care at home, please reach out to us. We can discuss your situation and explain what information or options may be relevant.

For Amy’s Mom specifically, if her oxygen levels continue to dip or her respiratory rate remains elevated, prompt medical reassessment is important. A critical care registered nurse may be able to provide additional monitoring and support where appropriate, but this does not replace a medical assessment or emergency care when needed.

If her oxygen saturation remains around 90%, falls further, or she develops worsening breathing, confusion, unusual drowsiness, chest pain, or other concerning symptoms, contact her treating clinician urgently. If she is severely breathless or deteriorating, seek emergency medical assistance.  The goal is to identify the cause, provide appropriate treatment, and reduce avoidable hospital admissions where this can be done safely.

That’s what we work towards with Intensive Care at Home. You can find more information at intensivecareathome.com.

For those of you watching this because you have a loved one who may be facing long-term ventilation, whether it is invasive ventilation through a tracheostomy, non-invasive ventilation such as BiPAP, CPAP, automatic positive airway pressure (APAP), or variable positive airway pressure (VPAP), or a tracheostomy without ventilation, I want you to know that alternatives to prolonged hospital care may be available for suitable patients.

Once again, that is where Intensive Care at Home may be able to help.  Intensive Care at Home is third-party accredited and registered with the National Disability Insurance Scheme (NDIS) in Australia. We have supported adults and children living at home with invasive ventilation, tracheostomies, BiPAP, and CPAP.  For suitable patients, this can mean receiving specialized nursing care at home with their families rather than remaining in a step-down unit or nursing home, provided the necessary clinical, staffing, equipment, and emergency arrangements are in place.

I always use this analogy: Would you board a plane without a pilot? Of course not.  So, why would a ventilator-dependent or tracheostomy patient be cared for at home without an appropriately trained critical care registered nursing team when their needs require that level of support?  Our model is designed to address that concern through specialized nursing and individualized care planning.  Patients may be able to leave ICU and remain at home with the appropriate level of support, depending on their clinical circumstances and care requirements.

Again, go to intensivecareathome.com to learn more.

Amy, here is my bottom line for you.

Your instincts are telling you that there are still questions to answer. Do not assume that low protein is necessarily an end-of-life conclusion until the underlying causes and appropriate treatment options have been discussed with your mother’s medical team.  Ask for a gastroenterology review if appropriate. Get all the medical records. Have them reviewed by someone who can help you understand what they mean for your mother’s treatment options.  We can help explain medical records in plain English and help you prepare questions for the clinicians involved in her care.  Ask the nursing home what its respiratory monitoring plan is. Ask whether it has the capability to monitor your mother’s oxygen levels, recognize deterioration, and respond appropriately to her clinical needs.  Specialist intensive care nursing, including respiratory support, may be available for suitable patients through Intensive Care at Home. Your Mom is fighting. Make sure her medical team understands your concerns and that you have clear answers about her ongoing care.

If you’re watching this and have a loved one in a similar situation, please reach out to us.  Visit intensivecarehotline.com, call one of the numbers listed at the top of the website, email [email protected], or book a call through the appointment button.

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Every week, I’m answering real questions from families navigating intensive care.

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.

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Your FREE Download: ICU Family FAQ: Nursing Home Discharge After ICU: Is Mom Out of the Woods?

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.