Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So, currently we are working with a client who has their 93-year-old mom in ICU initially with a chest infection. She ended up being intubated and she also has a percutaneous endoscopic gastrostomy (PEG) and a percutaneous endoscopic jejunostomy (PEJ) tube. And initially she should have been fed via the PEJ tube, but in ICU they fed her with a PEG and therefore she had aspiration pneumonia, which delayed her extubation or still delays extubation to this day.
Now, those are mistakes that can happen, but they also have a big impact on a patient’s outcome. There’s a big difference between a PEG and a PEJ tube. And if someone has a PEJ tube, the reason for that is often that feeds cannot be absorbed with a PEG tube. And therefore the PEJ tube has been inserted and that diminishes the aspiration risk for someone. So in this instance, obviously it looks like the hospital made a mistake or the ICU made a mistake by feeding them via the PEG.
Now, few days or two weeks later, the client’s mother is what seems like ready for extubation. She’s breathing on pressure support of 10, with a positive end expiratory pressure (PEEP) of 5, with adequate tidal volumes for this lady’s weight. Her blood gases seem to be good. Partial pressure of oxygen (PO2) seems within normal range. Partial pressure of carbon dioxide (PCO2) seems within normal range. She’s getting physical therapy, which is great. She’s getting mobilized. She’s got a cough, and she seems to be obeying commands. And the ICU team does not want to extubate her. They want to dry her out first, and they want to potentially look at some pleural effusions first and potentially drain that. Nevertheless, the ICU team also says that if they do extubate her and she for whatever reason, needs reintubation, that she would not get reintubated and that they would move her towards comfort care or also known as palliative care, or another term for it is end of life care.
And weeks ago, they wanted to do a tracheostomy early on and they wanted to send her to long- term acute care (LTAC). And obviously, this is for one of our clients in the U.S. in California. But in any case, the family at the time did not want to pursue early tracheostomy and early LTAC because as we all know, when patients go to LTAC, disaster strikes because LTACs or subacute nursing facilities are simply not equipped or have the expertise to look after someone on a ventilator with a tracheostomy.
So now, the ICU team wants to push the client again towards an ethics committee and towards risk management meetings and say that it’s “in the best interest” for this patient to die. And clearly, the patient has mentioned in the past with the family that she wants everything done. And when you look at Californian legislation, that is the right of a patient and a family to request that from hospitals, I mean, every person has the right to live. It’s not up to a hospital to determine when they should die or what treatment they should have, especially if treatment is available. So it looks to us like the hospital is clearly trying to delay extubation on purpose so she can potentially have end of life care, which is not what they want. Which also would be illegal if they try to push her towards that or have a tracheostomy and then send her to LTAC rather than extubating her because, by all accounts, by the information that we have, by accessing medical records, looks like this lady is ready for extubation. And the ICU team seems to purposely delaying that.
It’s disgraceful at times what we see in some hospitals, how they’re disrespecting patient’s wishes, patient’s right to live. Doesn’t matter whether someone is 23 or 93, patient has a brain that’s intact and she can make her own decisions. So, it is really important that you get informed. Get informed quickly, look at treatment options, look at, are they doing everything beyond the shadow of a doubt to get your loved one off the ventilator? Or are they doing everything beyond the shadow of a doubt to give your loved one best care and treatment? That’s really important that you look at that.
So that is my quick tip for today.
And if you have a loved one in intensive care and you’re struggling with similar issues, please contact us at 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 via email or in a membership area where we answer your questions about intensive care.
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Thanks for watching.
This is Patrik Hutzel from intensivecarehotline.com, and I’ll talk to you in a few days.