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

So currently, we are working with a client who has their 80-year-old dad in the ICU after a couple of heart attacks.

Initially, the client presented into ICU with a massive heart attack, ended up in the catheter lab, had one stent put in, ended up on the coronary care unit. He was monitored there, and then deteriorated with pulmonary edema, ended up in the ICU ventilated, and is now on low dose inotropes or vasopressors such as noradrenaline or norepinephrine. He is on a ventilator with a breathing tube, is in an induced coma with fentanyl and propofol. He is on the dialysis machine for an acute kidney injury, for acute kidney failure, and is also in liver failure.

So, the intensive care team is positioning this situation as multi-organ failure and dispositioning it in a way that it’s not in the “best interest” for the patient to have treatment continued it’s “in the best interest” to stop life support.

And I mean, I find this ironical over and over again. Since when is it in the best interest for someone to die? Unless someone, God forbid, wants to commit suicide. I have yet to find that out even after 20 years in intensive care. Well, what it comes down to is simply the intensive care unit needs beds. They want to save money. They have no interest in treating someone long-term in ICU because it costs them too much money and they have other patients queuing up for their beds.

Cutting the long story short, yesterday, I was in a family meeting over the phone with this client and played to what I believe is my strength, asking all the right questions. If they positioned it in a way that it’s “in the best interest” for this gentleman to die while I was asking all the right questions. How many inotropes? What’s the dose of the inotropes he’s on? What’s the ejection fraction of the heart? Is he making urine? What’s his ventilation settings?

And then it turned out, and here is where it gets really interesting, he’s on minimum ventilation settings, which means he’s actually fairly close to coming off the ventilator which means once sedation and the fentanyl and the propofol is stopped, he should be able to wake up. He should be extubated. If he can’t be extubated, he should have a tracheostomy or a trach.

It’s fairly simple, happens all the time in ICU. And very important for you to know, 90% of intensive care patients survive. So why should this gentleman be the 1 out of 10 that doesn’t survive?

Multi-organ failure can be survived in ICU. Yes, it takes time. It takes effort. But again, I have yet to find out how it can be “in the best interest” for someone to die. Unless someone, again, God forbid, one doesn’t want to live.

Now, the family has clearly indicated that this gentleman wants to live. He’s been through many challenges in his life, up until a few weeks ago. He was working full-time as a boilermaker. And that’s the way they look at their loved one and the intensive care team doesn’t look at it that way. They look at him as another patient in a bed space that’s taking up resources that they want to use for other patients.

Now, my quick tip here really is, you must never give up. You must ask all the right questions and you must have professional representation in family meetings because otherwise, they will walk all over you. You won’t be able to ask all the right questions. They will only tell you half of the story, which is exactly what happened yesterday. They were talking about that under no circumstances will he survive. And I challenged the intensive care team on that, and I said, “Well, I’ve seen these situations multiple times. Those patients do survive. You just don’t want to position it that way”.

The biggest challenge for families in intensive care is 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 where we are helping here thousands of families all around the world, every day when they read our case studies or when we engage with them one-on-one over the phone, or over Zoom.

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 send us an email to [email protected].

Also check out our membership site for families of critically ill patients in intensive care, intensivecaresupport.org.

Like this video, subscribe to my YouTube channel for updates for families in intensive care, click the notification bell, and comment down below what you want to see next, or what insights you have from this video, and post any questions.

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

Take care.