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Quick Tip for Families in Intensive Care: Can My Dad on a Ventilator Go to an ICU with Hyperbaric Oxygen Therapy?

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

So, today’s tip is again about one of our members. We’re answering a question from one of our members. So, we have a membership for families of critically ill patients in intensive care at intensivecarehotline.com where you can become a member as well if you have a loved one in intensive care to fast track you on making informed decisions, have peace of mind control, power, and influence. You can find more information at intensivecarehotline.com at our membership. If you are finding my videos valuable, subscribe to my YouTube channel for regular updates for families in intensive care.

So, let’s look at one of our members who has their dad in ICU and let’s answer her question.

She says, “We want to get out of this ICU and transfer to another ICU. So, I’m developing a separate list of ideas on how to get transferred. Tomorrow is Friday so we need to act quickly before the weekend, but it looks like we can’t make them to act quickly.

I have also attached the current medications my dad is getting. He received 3 units of platelets, 2 units of fresh frozen plasma, 3 units of red blood cells, and that was three days ago. His platelets were low. This has never happened to him before and the ICU attributes it to the antibiotics and the septic shock. I don’t think we can use a lot of these drugs because of his platelet issues. His blood pressure has gotten a lot better even though he’s on midodrine so using the drugs that make you hypotensive might be okay with close monitoring like you said.

Another question that I have is, can you do HBOT when you are on a ventilator? HBOT stands for hyperbaric oxygen therapy.  Are there any specific questions we should be asking? My plan is to go in with my spreadsheet and ask about every single treatment option listed. I will add iloprost as well and to push for a transfer to an ICU where they offer hyperbaric oxygen therapy, and there is a microvascular reconstructive surgeon. Neither of these is available in this ICU.

My mom sent me a picture that she took but it’s really horrible. I went there demanding answers on how it got to this point and why we weren’t told about it and proceeded to examine his entire body and found two other wounds. The nurse manager and patient advocate came in and scolded my mother and I, telling us we are making everyone uncomfortable. Does anyone care about my father?

Well, if the ICU nurse manager and the so-called patient advocate is telling you you’re making everyone uncomfortable, you should take that as a compliment. Take that as a compliment. You are in the 1% bracket of families in intensive care who are not pushovers, who actually make informed decisions, get peace of mind control, power, and influence and that is what makes them uncomfortable because you have clinicians on your team that know how to advocate and know how to ask the right questions. So, take that as a compliment.

“This is catastrophic, and I agree it could have been avoided. Who suffers? The man who is fighting for his life, my father. Any tips for what questions I can ask, how we can successfully transfer him to another ICU, and how we can save my dad’s finger? Thank you so much.”

Then she goes on, “The Doppler isn’t posted to the patient portal yet, but here are the notes from the vascular surgeon doctor. Skin: diffuse anasarca with blistering noted and lymphorrhea. External: left radial pulse, noted ABG (Arterial Blood Gas) draws, middle finger with cyanosis/ischemia to base or fingers with desquamation and deep tissue injury from second phalange distal.

She explained to us what that meant. We are devastated. Scrambling for treatment options and transfers. I called the nurse’s station a few hours ago and found out they haven’t even ordered the nitro paste yet. Just Betadine and the 4×4 loosely wrapped around his finger. So, I asked for the doctor. There are no intensivists there at night, no PAs (Physician Assistants), no NPs (Nurse Practitioner), just residents. That’s how it is during most of the day as well. She agreed to order the nitro paste but said, “The damage has been done.” I called back just now, and they finally applied the nitro paste. Where is the urgency?”

So, here is our response, “Thank you so much for all your emails and your explanations about your dad’s situation. Also, thank you for the pictures you sent us.

With regards to your question, “Can you do a hyperbaric oxygen therapy or HBOT when you are on a ventilator?” The answer is yes. Mechanical ventilation is a safe method for patients during HBOT and can be used routinely in ICUs where HBOT is available.” Not many ICUs have HBOT available so it’s a very specialist skill. It’s almost like ECMO (Extracorporeal Membrane Oxygenation), it’s a very unique specialist skill.

“Patients should be monitored, with their heartbeat, arterial pressure, and oxygen saturation should be frequently monitored and prevent further side effects or complications.

So, “What specific questions should you be asking?” You can ask the doctor as per his assessment of your dad, how many sessions of treatments of HBOT and how long, the number of hours a day and how many times per week will your dad be on this treatment? HBOT usually lasts two hours and are scheduled once a day, five days a week. The treatment sessions depend on how quickly the patient’s condition improves.

HBOT is safe with few risks and side effects. Some side effects are pressure injuries to the ears or lungs, low blood sugar, temporary vision changes, oxygen toxicity, confinement anxiety, et cetera. Hyperbaric oxygen therapy reduces ischemia-reperfusion effects, diminishing inflammatory effects while inducing free radical scavengers to block further tissue damage.

As per the list of medications, when we looked at your dad’s chart, your dad is on the antibiotics Piperacillin Tazobactam intravenous for his infections, Midodrine for his blood pressure, Amiodarone for his fast or irregular heartbeats, also known as AF or atrial fibrillation, Epoetin for his anemia, insulin for his glucose and sugar controls, Methylprednisolone for treatment of his inflammation, Pantoprazole for his stomach acidity treatment, silver sulfadiazine treatment for his wound infections, and albumin, a plasma expander which helps increase volume of blood plasma, avoiding shock, et cetera.

We feel very sorry about your dad’s left finger injury. The Doppler ultrasound and urgent referral and assessment to the vascular surgeon need to be done urgently to determine the extent and degree of the affected part. Is the pulse of the left radial present, felt, and palpable? The vascular surgeon will assess and determine whether the affected part can still be treated with medications and can be saved.

Dressing aseptically and application of prescribed cream, paste, and ointments should be applied as directed by the doctor to prevent the spread of the damage and to alleviate your dad’s pain and discomfort.

You can also ask to successfully transfer your dad to the other ICU, and you can seek advice there on how to save your dad’s finger, to know your rights, and how to deal with bad care and unacceptable staff treatment and approaches to patient’s family, saying that you and your mom are making everyone uncomfortable.” Once again, take this as a compliment. “And also get best advice regarding hyperbaric oxygen therapy and other possible best treatments that can save your dad’s finger from surgery.”

Also, you mentioned that your dad had blood products and they were able to reduce the vasopressors and reduce the Midodrine. That’s good because his blood pressure went up. So, that’s actually a good thing. You don’t want to be relying on vasopressors because the risk for pressure sores on vasopressors is much higher instead of reducing or switching off vasopressors. So, there’s a lot of advantages in coming off vasopressors.

Now, if you want your questions answered, like our member here who has their loved one critically in intensive care, go and have a look at our membership for families in intensive care at intensivecarehotline.com and click on the membership button there or go to intensivecaresupport.org directly.

Now, in our membership, you have access to me and my team, 24 hours a day, in a membership area and via email and we answer all questions, intensive care related and helping you to make informed decisions, get peace of mind, control, power, and influence.

Also, I offer one-on-one consulting and advocacy over the phone, via Skype, via Zoom, via WhatsApp, or whichever medium works best for you. I answer all the questions to intensive care teams you don’t even know you need to ask and get the answers to so that you can make informed decisions, and have peace of mind, control, power, and influence. I also represent you in family meetings with intensive care teams. I participate in them. Once again, I ask all the questions you haven’t even considered asking but must be asked.

I have worked in intensive care for over 20 years in three different countries. I have worked as a nurse unit manager for over five years, and I have been consulting and advocating for families in intensive care all around the world for the last 10 years. Just have a look at our testimonial section in our client podcast where we interview clients and the results and the outcomes we help them to get.

We also offer medical record reviews in real time so that you can get a second opinion in real time, once again, to help you get peace of mind, control, power, and influence and make informed decisions. We also offer medical record reviews after intensive care  if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

Now, if you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care, share the video with your friends and families, click the like button, click the notification bell and comment below what you want to see next or what questions and insights you have from this video.

Thanks for watching.

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

Take care for now.