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Quick Tip for Families in Intensive Care: Dad’s Ventilated, Rushed for Emergency Surgery of Infected Hand, Will Surgery & Antifungal Drugs Help!

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

So today I want to read out another question from one of our members. We have a membership for families of critically ill patients in intensive care. And you can get access to our membership if you go to intensivecarehotline.com and you click on our membership section 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. Now, let’s go to our member’s question who says,

“My dad was transferred to a bigger ICU on Saturday, September the 30th. He was rushed to the operating room for emergency surgery when they looked at his hand and his finger.

On Monday the 2nd of October, he went for a second major surgery on his hand. We have now learned that he has mucormycosis. It was never a clot in his hand, but mucormycosis also known as black fungus. They did a CAT scan yesterday and saw that it is in his lungs. Infectious disease said that there is very significant damage to the upper part of both lungs. 

My dad was started on Amphotericin B on Tuesday. They are doing a repeat Echo (Echocardiogram) of his heart, the CAT (Computerized Axial Tomography) scan of his brain, to see if it has spread anywhere else. Can you tell me if you have any experience with this fungus? If there are any treatments you know of besides surgical intervention and Amphotericin B, we have asked every question we can think of. 

They say that this is very, very, very bad and it is minute by minute, hour, by the hour.

Dad is breathing fine and is saturating at 50% of FIO2 (Fraction of Inspired Oxygen), 5 of PEEP (Positive End-Expiratory Pressure), 400 tidal volumes, and 15 respiratory rate. He is even breathing over the ventilator  a little bit, which means he’s breathing on his own. Please let us know if you have any ideas. 

Also, his White Cell Count has come down from the twenties to 14 since he started the Amphotericin B on Tuesday. The infectious disease doctor said when you are very sick, your body can either have very high numbers or very low numbers, which is accurate by the way. And she’s worried that numbers are going low now that the white cell count has come down because he’s responding positively to the antibiotics.

He is on a low dose of vasopressors compared to when he has been very sick. His creatinine is good and they have been giving CRRT (Continuous Renal Replacement Therapy) dialysis on and off because his body temperature gets too low. It was 92 °F yesterday. He has been talking about a little bit and responding to little bits.”

Well, thank you so much for sharing your dad’s situation with us and I have actually read out other emails from this particular member. Of course, when I read out emails, it’s all we’re protecting the identity of our members. Of course, we’re not mentioning any names here, but I have read out other emails from our member here in the past.

So thank you for your email about mucormycosis also known as black fungus. It is rare but a dangerous infection caused by a group of molds, mucomyst that affects the sinuses, lungs, skin and brain. Mucormycosis is a fungal infection and is curable when diagnosed and treated early.

Warning signs of black fungus are blackening or discoloration over the nose, blurred or double vision, chest pain, breathing difficulties, and coughing of blood, et cetera. Others may manifest symptoms like fever, nausea, nasal congestion, bleeding from the nose, facial pain and numbness, black nasal discharge, sinusitis, eye complaints, and/or problems with visions. Symptoms of mucormycosis in the lungs, which is pulmonary mucormycosis are fever, blood in the sputum tissue, infarction, consolidations, pulmonary nodules, findings in the Chest X-ray, et cetera. Symptoms depend upon the infection where the fungus grows in the body. The risk depends on the area of the body involved and the overall health of the patient. Patients with untreated pulmonary mucormycosis usually die from disseminated disease before respiratory failure occurs.

Mucormycosis is a serious infection that needs to be treated with antifungal medications, usually Amphotericin B, Posaconazole, Isavuconazole et cetera. The infectious disease team needs to be consulted regarding your dad’s fungal infections, blood cultures and sensitivity tests, screening of his urine/ stool, respiratory secretions and wound swab culture must be tested, analyzed, or investigated to determine the specific causative microorganisms present in his body and the appropriate antibiotic therapy to prescribe.

Antibiotic medications are commonly prescribed and given through veins, intravenous route or by the oral form of antifungal medications, posaconazole, isavuconazole, et cetera. In your dad’s case, he would have an IV through the central line.

For patients who develop fungal balls in the lungs, surgery is the best option if the mass is in a good location to be removed. Though sometimes antifungal medications are prescribed but have been found to have little effect.

One way to fight fungal infections aside from the antifungal intravenous medications is to boost the immune system, by incorporating immune-boosting foods into the diet, which also helps such as diet rich in vitamin C, antioxidants, zinc, yogurt, et cetera.

There are antifungal properties or foods that work to control fungal imbalances and treat symptoms. A registered dietitian and nutritionist can help prescribe the right diet for fungal infections. There are some simple home remedies like apple cider vinegar, turmeric mixed with warm water, turmeric tea, ginger, which has antifungal properties. Local application of tea tree oil, coconut oil, aloe vera, garlic, oregano oil, neem leaves, baking soda, hydrogen peroxide, honey.

Your dad had started his intravenous antifungal medications. The prognosis and defect of this antifungal medication like Amphotericin B also known as Ampho B also depends on how your dad will react to this medication. Before this Amphotericin B is started, the test dose is administered. He had started Amphotericin B last Tuesday, which means that he had no adverse reactions to Amphotericin B. Make sure that his intravenous access is patent with good backflow of blood so that the drug is surely administered in your dad’s body systemic circulation.

I have taken care of many patients including pediatrics with fungal infections in the blood. The majority of them had a good effect in response to antifungal medications like Amphotericin B, Amphotericin B Liposomal, Fluconazole, Metronidazole, etc. Once the treatment has been started early, there’s a very good chance to control or stop the fungal infection from spreading to other parts or organs of the body. Good chance to control, fight, and treat fungal infections.

Your dad’s condition and response would be a big factor and a great help for his recovery. Your dad must maintain good airway ventilation and oxygenation. He must tolerate his feeding, good proper nutrition for him to fight opportunistic microorganisms, infections, suction or prevent accumulation of respiratory secretions, must regularly pass a good amount of urine and stool to eliminate the bacteria and toxins in the body. He must mobilize to promote blood circulation and ventilation, oxygenation, avoiding complications must prevent stress, observe hygiene, and avoid getting the new cause of infections. Good sleep, rest, proper diet, medications, and physical chest physiotherapy or chest exercises like deep breathing and coughing exercises need to be done. All these will help your dad in his recovery and prevent serious health problems.

The breathing rate of your dad on the ventilator is 15 per minute, PEEP of 5 cm of H2O, and tidal volume of around 400 mls. Question is, what is your dad’s weight? 70 or 80 kg? The ventilator setting is providing minimal support to your dad,  his oxygen saturation is 100%. FIO2 is at 50%. You can suggest to the respiratory therapist or to the doctors and nurses to observe and monitor your dad’s oxygen saturation. And if he continues to maintain saturations above 94% and above in the pulse oximeter or cardiac monitor, the set FIO2 from the ventilator can gradually be decreased. It also depends on arterial blood gases. What is his PO2 (partial pressure of oxygen) in the arterial blood gas? What is his PCO2 (partial pressure of carbon dioxide) in the arterial blood gas? It all depends on that as well. If PO2 is above 80 or 90 mmHg and CO2 (carbon dioxide) is within a normal range, FIO2 can be reduced as well. So continue to ask doctors, nurses, and respiratory therapists about this matter since he is the best person to do these adjustments in the machine and monitor your dad’s tolerance.

It is good to note that your dad’s White Blood Cell Count has decreased. Blood investigations like complete blood count, chemistry panel, liver function test, C-reactive protein (CRP), white  blood cell count, electrolytes, hemoglobin, et cetera must be monitored to anticipate impending diseases and for early detection and interventions.

Your dad’s White Blood Cell count is 14, which is not low. Normally, it’s up to 11, basically from 4 to 11. It slightly varies in every hospital’s lab results. But if your dad’s WBC white cell count continues to decrease, it can be a sign of an underlying medical problem or may increase his risk of getting infections.

Decreasing the white cell count level needs also an investigation to uncover the root cause. The white cell count fights diseases and is important for the body’s defense against infections. If his white cell count is low, it can make your dad vulnerable to infections. The signs and symptoms of infection are fever, chills, sweating, feeling tired, fatigue, body weakness, headache, et cetera.

Low body temperature is one of the complications or side effects of CRRT. It occurs from heat loss due to extracorporeal blood circulation. So CRRT stands for Continuous Renal Replacement Therapy, also known as hemodialysis or hemofiltration. ICU nurses will aim to prevent the developing low body temperature of the patient by adding intravenous fluid warmers to the dialysis circuit, in an attempt to maintain the patient’s acceptable body temperature. Also wrapping the dialysis circuit into warming foil, seen that too.

A CT scan, echo and other imaging studies need to be repeated a few days a week after starting the antifungal treatment for comparison. And to determine the effect or response and improvement of your dad to therapy. Blood investigations must likewise need to be monitored.

May your dad find strength with each new day. Bring him closer to safe healing and full recovery.

Also, make sure they’re weaning him off sedation and opiates. Make sure they keep reducing the breathing rate on the ventilator so he can breathe more and more for himself to wean him off the ventilator.

Don’t lose sight just because he’s got this severe infection that he mustn’t come off the ventilator. That should be your goal. Don’t lose sight of that just because he’s got the infection. Get him off sedation. Get him out of the induced coma, weaning off the ventilator. That must be your ultimate goal.

Thank you so much for sharing this and I hope this email helps you and this video helps you to take the next steps in your dad’s recovery.

Thank you so much.

Now, if you have a loved one in intensive care and you need help, you can also become a member as part of our membership here for families of critically ill patients at intensivecarehotline.com. Go to intensivecarehotline.com. Click on the membership link and you can get access to our membership. You can also 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. I also offer one on one consulting and advocacy over the phone, via Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to intensive care teams directly; ask all the questions you haven’t even considered asking but must be asked in a situation like that. And I’ll make sure you make informed decisions, get peace of mind, control, power and influence.

I also represent you in family meetings with intensive care teams so that they don’t walk all over you. Again, I help you making sure you have a strong voice and I know what they say. I know how they say it. I know when they say it and I also know what they’re not telling you because at least they don’t even give you 50% of the information that you must know and I will ask all the questions making sure you have all the information you need to know.

Now, we also offer medical record reviews in real-time so that you can get a second opinion in real-time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure or if you’re simply suspecting medical negligence.

Now, for any of that, go to intensivecarehotline.com and call us on one of the numbers on the top of our website or email us to [email protected].

Now, 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, share the video with your friends and families 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.