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

So, at the moment, we are working with a client who has their 82-year-old husband in ICU. He’s currently ventilated after he’s had a heart attack. He’s having a breathing tube and he had to be reintubated after a failed extubation in the last couple of days. Now, it looks like he may be heading towards the tracheostomy but we hope he may have a chance of extubation in the next few days as well.

In any case, what’s happening there as well is that her husband is losing a lot of weight and what used to be sort of an 85 kg man is now down to nearly 60 kg. So, he’s lost a lot of weight and she’s very, very worried that if he’s losing more weight, he will be losing strength.

Now, he’s got a nasogastric tube in situ and he’s getting some Nepro feeds because he’s also in kidney failure. The question is, how can the intensive care team make sure he’s gaining some weight? Lo and behold, studies have been done that patients in ICU just need the same level of calories than a healthy person because fighting a critical illness takes energy and without feeds in ICU, without nutrition, you can’t really fight a critical illness.

Cutting a long story short, so, let’s just say someone only gets 60 mls an hour of enteral feeds, either nasogastric tube feeds or PEG (Percutaneous Endoscopic Gastrostomy Tube) feeds and they’re not meeting their calories and they’re having issues in digesting the food because what sometimes happens in ICU as well when patients are in an induced coma, their gut motility might be slowing down because of all the medications for sedation and opiates. Therefore, they are at risk of aspiration. They have high residuals in the stomach, i.e., they might not absorb the feeds as quickly as possible, and they might have residuals up to 500 mls. So, that is a risk for aspiration and for vomiting.

Let’s just say someone like, in this situation, is still losing weight, what else can be done? What can be done is you could use high concentrated feeds to get the volume down and still give more calories and carbohydrates and fat and sugars and whatever else a patient needs, or you could also start some TPN, also known as Total Parenteral Nutrition, also known as intravenous nutrition. So, that is another option as well. So, you can actually run both simultaneously.

Now for TPN for Total Parenteral Nutrition or also known as intravenous nutrition, the patient needs a central line or a PICC (Peripherally Inserted Central Catheter) line or a Hickman’s line, or a portacath to have the TPN connected. So, there is certainly an increased infection risk but if doctors and nurses use a sterile technique to connect and disconnect the TPN, there shouldn’t be any issue.

But a lot of families in intensive care do not know anything about TPN at all. When someone has nasogastric tube feeds or PEG feeds and they’re losing weight, something is clearly not working. By starting TPN or intravenous nutrition that will help gain some strength back, will help and get some nutrition and energy back.

So, that is definitely an option.

Now, one word of warning is that for patients in ICU, the aim is often to have a negative or an equal fluid balance. So, you got to look at what’s going in is also going out so that the patient is not ending up in fluid overload. Sometimes diuretics can be used such as Lasix or Furosemide or spironolactone. Or if the patient is in ICU on dialysis, maybe they need to increase the fluid removal as well.

So, that is my quick tip for today.

I hope that helps you understand whether nasogastric tube or PEG tube feeds can be given with TPN simultaneously. The answer is absolutely yes. There is nothing stopping a patient from getting TPN simultaneously with nasogastric tube feed or PEG feeds.

Now, I have worked in critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com

You can verify that by going to intensivecarehotline.com and looking at our testimonial section and see what our clients say. We have saved many lives over the years with our families in intensive care with our clients. Again, that’s all documented in our testimony section, or you can look up our podcast section where we’ve done some client interviews.

Because we’re getting so many questions for families in intensive care every day, that’s why we created a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com if you click on the membership link or you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email and we answer all questions, intensive care related.

In the membership, you also have exclusive access to 21 e-books and 21 videos that I have personally written and recorded. All of that will help you to make sure you make informed decisions, you have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

I also do one-on-one consulting advocacy for families in intensive care. I talk to you and your families directly and I handhold you through this once in a lifetime process that you simply can’t afford to get wrong. Once again, when I talk to you directly, I make sure you make informed decisions, you have peace of mind control, power, and influence, making sure your loved one gets best care and treatment. I also talk to doctors and nurses directly and ask all the questions that you haven’t even considered asking but must be asked when you have a loved one in intensive care. I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send an email to [email protected].

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

I also do a weekly YouTube live where I answer your questions live on the show. You will get notified for the YouTube live if you are a subscriber to my YouTube channel or if you are a subscriber of our intensivecarehotline.com email newsletter that you can subscribe to at intensivecarehotline.com.

If you want your question answered quickly and fast because I have so many emails sitting, make a small donation to the super chat button here on YouTube and I will get to your email straight away. You can also make a donation regardless if you like my videos. A small donation will help that we can make more videos for many families in intensive care, and we can help more and more families in intensive care.

Thank you so much for watching.

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

Take care for now.

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Quick Tip for Families in ICU: Can You Have a Tracheostomy While in an Induced Coma? Quick Tip for Families in ICU: Is ICP & Tracheostomy Needed After Subarachnoid Haemorrhage in ICU? Quick Tip for Families in ICU: Why Do ICU Patients Go Back On The Ventilator? Quick Tip for Families in Intensive Care: COVID-19 and ARDS, When is ECMO an Option? Quick Tip for Families in Intensive Care: My Husband had a Stroke with Tracheostomy & Ventilator! Can INTENSIVE CARE AT HOME Take Him Home?