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

So currently we are working with a client, a 40-year old lady who is in ICU with COVID ARDS. And whilst the COVID and the ARDS  is clearing up, while she’s slowly making progress with pressure support trials on the ventilator, now she’s experiencing other challenges, such as an empyema in her lungs and also heart failure with a significant drop off her ejection fraction. And she’s now being treated as a heart failure patient as well.

So several challenges that have come up there whilst the lady was making progress up until last week. All of a sudden she developed empyema and she had some TPA (Tissue Plasminogen Activator) for that, or she’s having ongoing TPA (Tissue Plasminogen Activator) for that for drainage. And she’s now also developed cardiac failure or heart failure. Initially her ejection fraction was around 80% and now it’s dropped significantly down to 35%, which obviously puts pressure on the left ventricle on the left side of the heart, which means all organs are not getting as well perfused as they were getting perfused previously.

So therefore, she has been started on milrinone for the heart failure, other drugs that can be used in a situation like that are dobutamine. Sometimes it is also supported by noradrenaline or norepinephrine, depends on the condition. How can heart failure be diagnosed? It’s often diagnosed by obviously a significant drop in blood pressure and it’s often also diagnosed by doing ultrasound or the TOE, a transesophageal echocardiogram, where the ultrasound is put into the esophagus.

So how does heart failure develop in a critically ill patient? Well, it’s hard to say, and I can’t cite any studies here and I’m sure there are some studies out there, but especially with COVID, I do believe we’re all walking in unchartered territory and it could just simply be a strain. The lady has been in ICU now for nearly 70 days, and it just could be a strain of the disease process. It could be a strain of being ventilated for nearly 70 days that puts strain on the heart from all the pressures in the lungs. So there could be a number of reasons why someone is developing heart failure while they are in intensive care.

Now that is my quick tip for today.

If you have a loved one in intensive care, go and check out intensivecarehotline.com. Call us on one of the numbers on the top of the website, or send us an email to [email protected].

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