Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

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

So, today’s tip is about again, a question from a reader which is a very good question. Our reader, Lauren says, “How do I really know if my husband’s organs are shutting down? He has been on a ventilator for two weeks after a stroke and the ICU team is telling me that there’s no hope. His organs are shutting down.”

Ok, great question. So, let’s just set the scene here.

The first thing that you need to know is that approximately 90% of patients in intensive care do survive. That means the odds are in your husband’s favor.

Now, next, let’s look at all the major organs: brain, heart, lungs, liver, and kidneys. How do you know if the ICU team is telling you that this multi-organ failure is accurate? How do you know that the organs are shutting down? So, ok, let’s start from the top.

Let’s start with the brain. Well, if the brain is shutting down, it means that someone is unconscious and is not waking up. That can be determined by lack of neurological response. So, it is someone who is not waking up, someone who is not responding at all, someone who has a Glasgow Coma Scale of 3. I urge you to check out the Glasgow Coma Scale. I don’t have the time in this video to explain about Glasgow Coma Scale, but someone who has a Glasgow Coma Scale of 3, their pupils might be nonreactive to light, they might be unequal and nonreactive to light and so forth. So, that would be one sign that the brain is shutting down. Another sign would be that your husband is not waking up despite being off sedation for many days and there’s no sign of waking up. That could be one sign from a brain perspective.

Let’s move down the body and let’s look at the lungs. When are the lungs shutting down? Well, the lungs are shutting down when ventilation requirements are going up. You mentioned that your husband is on a ventilator. So, if his FIO2 is going up, the oxygen that he needs, if that’s going up, all the way up to 100%, if his PEEP (positive end expiratory pressure) requirements are going up, if his pressure support requirements are going up, if his tidal volumes are going down, if the correlating blood gas is poor, those would be signs that your husband’s lungs are shutting down. A chest X-ray would confirm that the lungs are shutting down. Those would be signs there. And if your husband can’t come off the ventilator and he’s on high oxygen support, high PEEP support, high pressure support, and x-rays are really looking poor, that also means he couldn’t have a tracheostomy because it would be deemed unsafe to perform a tracheostomy. So that could be another sign.

Next, from a heart perspective. If the heart is shutting down, it means that blood pressure is low, and your husband would need to be started on inotropes or vasopressors. That could be one sign. Another sign could be that there’s heart failure and there’s pulmonary edema which then links back to the lungs. Another sign could be that, despite inotropes or vasopressors such as noradrenaline, norepinephrine, dobutamine, dopamine, milrinone, adrenaline, epinephrine and so forth, the blood pressure isn’t going up and that the peripheries are pretty cool. What that means is, the extremities – feet and hands, are really cold and potentially are also purple or blue, which often goes hand-in-hand with lactate going up. Another sign that organs are shutting down is that lactate is going up in the blood results. So, ask for a lactate result. Another sign with the heart in particular is an ultrasound of the heart which can also confirm if the heart is not working properly. For example, if ejection fraction is really poor.

Next, kidneys. When kidneys are shutting down, it means that urea and creatinine are going up or BUN is going up, and low urine output. That is often a sign when the kidneys are shutting down that can be treated with dialysis or hemofiltration. But it also means there needs to be a decent blood pressure that’s compatible with life ideally without inotrope or vasopressor support.

Next, what if the liver is shutting down? Again, you would see that in liver enzyme results in the blood tests and you would also see that a patient might potentially have jaundice. So those are the major signs for the organs if your husband’s going into multi-organ failure and all the major organs are shutting down.

Now, having said that let’s just paint the worst-case scenario here. Just because your husband’s organs might shut down, that doesn’t necessarily mean he can’t survive. I’ve seen plenty of patients in ICU after having worked in intensive care for over 20 years in three different countries and having looked after hundreds, potentially thousands of critically ill patients and their families. I have seen patients coming out of multi-organ failure. Once again, keep in mind, 90% of patients in intensive care approximately survive so why should your husband be 1 out of 10 not surviving?

Do not give up hope here. And just because the intensive care team is negative, you got to do your own research, which is what you’re doing here and that’s great. But you have to dig deeper, and you also have to make sure in a situation like that, that your husband is getting the best care and treatment.

So, they might be telling you that your husband’s organs are shutting down, but they’re not offering him the best care or treatment. So that is really important that you get a second opinion, and you get consulting and advocacy, making sure they’re doing all the right things. What if they’re telling you your husband is going into multi-organ failure and they could prevent that by giving him more treatment or alternative treatment that they haven’t told you about? Intensive care teams are notorious for only telling families in intensive care not even half of the story. We’ve seen that over and over again. So, I hope that helps.

And that is my quick tip for today.

If you have a loved one in intensive care, go to intensivecarehotline.com and call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

Also have a look at our membership for families in intensive care at intensivecaresupport.org. There 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 1:1 consulting and advocacy with you over the phone via phone, Skype, Zoom, WhatsApp, whichever medium works best for you. And I also talk to intensive care teams directly. I represent many families in intensive care and intensive care teams and we’ve turned situations around for families in intensive care very, very quickly. As soon as the intensive care team knows you’re talking to someone who understands intensive care just as well as they do, things will change for you, and they have to be transparent because I ask questions that you haven’t even considered asking.

If you need a medical record review in real time, please contact us as well. We review medical records for patients in intensive care in real time so that you can have a second opinion. We also review medical records after intensive care if you have unanswered questions. If you are suspecting medical negligence or if you simply needed closure, we could help you with that as well.

Now 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 or what questions and insights you have from this video. Share the video with your friends and families.

Thank you so much for watching.

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

Take care for now.