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

So today’s tip is about, should you send your loved one to LTAC with multiple comorbidities?

Now, we are currently working with a client who’s been in ICU for three weeks after COVID pneumonia. He’s got several comorbidities, including severe chronic heart failure and his ejection fraction is only around 15 to 20%, which is very low, which means the heart is not pumping properly. The contractility of the heart is decreased and that’s in and of itself a significant issue that often keeps people in ICU and it needs involvement of a cardiologist. Potassium levels need to be maintained. There’s often ongoing monitoring that needs to be done because of the risk of atrial fibrillation, of PVCs (Premature Ventricular Contractions) potentially going into VT/VF (Ventricular Tachycardia/Ventricular Fibrillation). There’s all sorts of issues attached with that.

Next issue this particular client has, he might have had a mini stroke in the last few weeks which has been shown on a CT scan of the brain. Next issue, this gentleman does have is elevated LFTs (liver functions tests). So he’s got a little bit of liver failure and that is possibly caused by the heart failure and also by a huge cocktail of medications that he’s taking at the moment while in ICU.

Next, the kidneys seem to be working okay, but he’s obviously on a ventilator with a breathing tube. So he’s got multiple comorbidities. He hasn’t been able to come off the ventilator yet at the moment they are deliberating, whether he should have a tracheostomy after three weeks in ICU, and whether he should have a PEG (Percutaneous Endoscopic Gastrostomy).

Now they have been giving this gentleman morphine intermittently because of pain. Obviously the main side effect of morphine is respiratory depression. And so far he’s failed every single weaning trial ie when they changed him from a controlled mode to CPAP or pressure support, he’s failed those trials so far.

So now the ICU team is advocating for tracheostomy and for a PEG tube and wants to send him to LTAC as quickly as possible. Now we are advising the client not to consent to a PEG, possibly consenting to a tracheostomy because the gentleman is very weak after three weeks in ICU, after in and out of an induced coma. But the bottom line is this with those multiple comorbidities, if he goes to LTAC, there’s no specialist input. In LTAC, it’s often one doctor for 30 patients, one nurse for 10 patients, and those nurses are often not ICU trained, which means a move or a discharge to LTAC is often only motivated by money, not by clinical need. And that’s very concerning.

If you look at the reviews for many LTACs across the United States, they’re fairly poor. We have literally people begging us getting their loved ones or helping them getting their loved ones out of LTAC. And it’s just not a good place to be. Let alone, it’s not a good place to be with multiple comorbidities.

That is my quick tip for today.

Like this video, comment below what you want to see next, subscribe to my YouTube channel for updates for families in intensive care and click the notification bell.

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].

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

Take care.