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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So today’s question is about, should you do a tracheostomy after COVID-19, ARDS or lung failure, ECMO and the cardiac arrest?
So that’s a sort of a three to four step question I’m going to answer today so stay tuned.
So currently we are working with a client who has been diagnosed with COVID-19 about 30 days ago. The client ended up in ICU initially on a ventilator because of respiratory failure, went into ARDS also known as lung failure, ended up on ECMO, which is basically taking over the functions of the lung for a period of time so the lungs can rest and heal.
When the client went on ECMO, he had a cardiac arrest and he potentially sustained a hypoxic brain injury from the cardiac arrest because his brain was potentially starved from oxygen during the cardiac arrest.
So now about 30 days later, he’s off ECMO. The lungs are slowly recovering and he’s not waking up and EEG and MRI has actually shown that there is most likely brain damage and his Glasgow coma scale is about a 4 or 5, and he’s not waking up even though he’s been off sedation for about 12 days now.
So the question now that the family is struggling with is, should they do a tracheostomy? Should they give him more time to wake up because he can’t come off the ventilator yet. And he may never be able to get off the ventilator and with the potential brain injury, he probably will need a tracheostomy for the rest of his life because he won’t be able to swallow.
And if he can’t swallow without a tracheostomy, he’ll end up with secretions in his lungs and he ends up with another pneumonia. So if the family wants to give their loved one time to wake up and not to die, they should be asking for a tracheostomy that would give him time to wake up.
Now there’s no guarantees of course, but the alternatives are pretty grim and the alternatives would be to remove the ventilator and basically let nature take its course or even hasten death with sedation, such as morphine or midazolam or fentanyl and that could potentially be perceived as euthanasia.
So they are very tricky questions to be asked, but in order to save a life and give the loved one more time to wake up and potentially recover, go to a neurology rehab, a tracheostomy would be the natural next step. That is my tip for today.
And also, very quickly adding onto this, especially with services now like intensive care at home, with tracheostomy patients can go home and leave intensive care and have intensive care at home as well, so there are options and alternatives for situations like that as long as you as a family agree on those steps.
So that’s my tip for today.
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If you have any questions, contact us on one of the phone numbers on the top of our website, intensivecarehotline.com, and thank you for watching.
This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days.