Quick Tip for Families in Intensive Care: High Flow Oxygen, Nasogastric Tube for Nutrition & Water. My Dad’s Aware, Responding & Wants to Fight. ICU Wants Hospice!
Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
Today’s tip is again a question answered from one of our readers who says, “My husband is in ICU with high flow nasal oxygen, nasogastric tube for nutrition, and just some water as well. He is awake, aware and he’s responding that he wants to fight, and everything needs to be done to keep him alive and get him better. The ICU wants to remove the nasogastric tube and put him in hospice. What should I do?”
Well, it sounds to me like your husband has been coming off the ventilator, has managed to get off the ventilator or didn’t need the ventilator in the first place, but he is on high flow nasal oxygen. And whatever is the underlying condition you haven’t shared, however, why should he not fight? I mean, it’s not up to the ICU to decide whether he’s going to hospice or not. The ICUs job is to do everything that they can to improve his situation so that he can recover, rehabilitate, and eventually go home.
So, don’t let anybody talk you into that hospice is the best thing for your husband. It doesn’t sound like you do and it doesn’t sound like your husband will either. But it’s entirely up to you what treatment options need to be offered to your husband and obviously you’ve got your husband on your side. It’s always better if you have it documented in an advanced care plan, which is a legal document. But even if you don’t have an advanced care plan, you should still advocate for your husband to have everything done that they have available for him. And there’s more available for your husband than just hospice. Hospice will be the end of the road and that’s not what you want. You haven’t shared how old your husband is, but even age isn’t a fact that, it’s about honoring patients and family’s wishes.
Now, here is what I would recommend that with what you’ve shared with me especially with high flow nasal prongs. I would strongly recommend that your husband should have physical therapy as quickly as possible. Get him out of bed, get him mobilizing, that is assuming he’s hemodynamically stable that he’s not on inotropes or vasopressors, do deep breathing exercises, coughing exercises, see whether they can get the oxygen and flow levels down on the high flow nasal prongs. Also, I would look at chest X-ray results, arterial blood gas results, which would be important, to see what else is going on and what else could be done to improve his situation.
Now, other things that you could be looking at down the line are if his situation stagnates or he’s not improving, look at options like Intensive Care at Home. So, with Intensive Care at Home, we are sending intensive care nurses into the home predominantly for long-term intensive care patients. And it sounds to me like your husband might be in intensive care for quite some time. So, we have looked after patients at home with high flow nasal prongs. We’re also looking after patients at home that are stuck in intensive care for a long time, such as long-term ventilation and tracheostomy or tracheostomy without ventilation or noninvasive ventilation such as BiPAP (bilevel positive airway pressure) /CPAP (continuous positive airway pressure), without tracheostomy. So high flow nasal prongs are right along the lines here and you can find more information about Intensive Care at Home at intensivecareathome.com.
Now, we are currently operating all around Australia. We are National Disability Insurance Scheme (NDIS), Transport Accident Commission (TAC), iCare, National Injury Insurance Scheme (NIISQ) and the Department of Veterans’ Affairs (DVA) approved nursing service provider in Australia. We have a large team of critical care nurses coming into your home and offering critical care in the home.
Now, we also offer Level 2 and Level 3 NDIS specialist support coordination to help you with funding. So please reach out to us at intensivecareathome.com.
If you’re not in Australia, I would focus on, improving your husband’s situation in ICU. And contact us as a matter of urgency because we can help you with the advocacy, look at the medical records, talk to doctors and nurses directly and give you a second opinion, besides the ICU team telling you, “Oh, well, the only way forward is hospice”. That’s a lot of nonsense, generally speaking.
Approximately 90% of intensive care patients survive. So, why should your husband be in the 10% bracket of people not surviving? They just need to keep doing the right things, need to give him the treatment he needs, and so forth. What’s the underlying cause? Does he have a pneumonia? Chest infection? Are they giving antibiotics? Have they isolated the source of infection? Is it pneumonia? Is it a chest infection? Is it a urinary tract infection (UTI)? Is it a sepsis? What’s the underlying reason here?
Generally speaking, when you send us emails, the more information you can send us the better. But it also comes back to that, the biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care. And that’s exactly what’s happening here. To a degree you are at your wit’s end, but the good news is we can help you very, very fast.
Now, that’s my quick tip for today.
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 simply send us an email to [email protected].
Also, have a look at our membership for families of critically ill patients in intensive care at intensivecaresupport.org. There, 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 and Intensive Care at Home related.
I also offer 1:1 consulting and advocacy for families in intensive care over the phone, via Skype, via email, via WhatsApp, Zoom, whichever medium works best for you. And you can contact me again at intensivecarehotline.com.
I talk to doctors and nurses directly and ask all the questions that you haven’t even considered asking, but you must ask if you want peace of mind, control, power, influence and if you want to make informed decisions fast. I also represent you in family meetings with intensive care teams so that once again, you will have an advocate there by your side. If I were you, I would not go into any family meetings without having a clinical advocacy by your side. Otherwise, the intensive care team will walk all over you.
Also, we offer medical record reviews in real time so that you can have a second opinion in real time so that you can make informed decisions, have peace of mind, control, power, and influence. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.
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Thank you so much for watching.
This is Patrik Hutzel from Intensive Care Hotline and intensivecareathome.com, and I will talk to you in a few days.
Take care for now.