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Quick Tip for Families in Intensive Care: ICU Wanted to Stop Life Support on My Uncle. Now He’s Pulling Through. Thanks to You’re Advice!

 

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

Today’s tip is more of a case study really. We are currently working with a client who has their uncle in ICU. The uncle is in his late 60s and he went into ICU possibly mid-December and had an aspiration pneumonia initially, which was followed by many complications including sepsis. Ended up with kidney failure, ended up with a below knee amputation, many pressure sores. And the family eventually reached out to us because the intensive care team was trying to push towards end of life. And at the point when the family reached out to us, it was a case of the intensive care team wanted to withdraw treatment the next day. The very next day at three o’clock. So, we had not much time left to put a stop to that.

The intensive care team had already rallied the ethics committee and they were basically saying, “Well, the ethics committee decided that it’s “in the best interest” for this particular patient to die.” And obviously, the family was shocked by that statement and reached out to us, and we could help them by (A), educating them on their rights, and (B) by educating them on the clinical side of things. After we’ve spoken to the doctors, we could find out that there was no need to withdraw treatment and that this gentleman deserves every opportunity to live and deserves the right to live.

Anyway, where am I going with this? The family is still furious to this day that the hospital was treating them so badly and that the hospital, what they perceived was devious by literally trying to kill their uncle.

What happened in the meantime? They were also denying him a tracheostomy to begin with. They said, “Well, he should have a one-way extubation.” Whereas we said, “Well, why can’t he have a tracheostomy?” And then the hospital said, “Well, if they did a tracheostomy, they can only do a tracheostomy and a PEG tube.” It wouldn’t be a tracheostomy only because we said, “Well, PEG tube is not really necessary.” This client is in the U.S., by the way, a PEG (percutaneous endoscopic gastrostomy) tube is not really necessary because a tracheostomy and a nasogastric tube will just do fine to do the ventilation side of things as well as the nutrition side of things.

So, in any case, the family felt very much bullied by the hospital to agree to end life support for their uncle, and he would’ve died if they had given in. They thought they can just do that without anyone challenging them. And then obviously we explain to the family that end of life does not happen in a vacuum. End of life happens with laws, policies, and procedures. You can’t just take someone off life support against their wishes or against the medical power of attorneys’ wishes. So, we educated them on their rights, and then things changed very quickly from that point forward.

Also, the family asked us to speak to the doctors directly, so we got a really good understanding on what’s happening clinically. Again, from our perspective, there was absolutely no need to withdraw treatment. Cutting a long story short, this gentleman now had a tracheostomy done on the 16th of March, and he’s now already having some spontaneous breathing trials.

Now, again, he had below knee amputation. He’s also got severe pressure sores around his sacral area, around the hip, and he probably needs a flap to have some of his pressure sores repaired, but he might even need a colostomy because one of the pressure sores is right at the sacral area. The patient does need a rectal tube in order to have the pressure sore to heal, because currently, if he’s got diarrhea and the pressure sore won’t heal because the position of the pressure sore is just around the anal area around the sacrum. So, it’s really challenging.

A patient in ICU or in the hospital should never have Stage 4 pressure sores, which is what’s happened here. This man has Stage 4 pressure sores, which is very, very concerning because that’s clearly a sign that he hasn’t had enough nursing care, hasn’t had enough pressure area care, and that could be perceived as negligence.

Now, but moving forward, we are now, as the time of me recording this video, it’s the 2nd of April. He’s been in hospital for a long time. As I said, the hospital has been trying to push to not prolong treatment, but now this gentleman is actually awake. Since he’s had a tracheostomy, they were able to remove all sedation, but he’s still in a lot of pain because of his pressure sores.

Now, he’s had some spontaneous breathing trials in the last few days. He’s breathing on pressure support, 15 over 5 with an FiO2 of 40% at least for 5 to 10 hours a day, and then overnight he goes back into an SIMV (synchronized intermittent mandatory ventilation) mode. Now, bear in mind, this is a man where the ethics committee said he can’t or he shouldn’t live, and they wanted to withdraw life support. Well, the family’s forever grateful they could find us and could get some advice from us, and how to turn this situation around, because now that the gentleman is awake. He’s also made very clear that he wants to live and that he wants everything to be done. His brain is intact. And I was surprised to begin with why this gentleman couldn’t be woken up and he could be asked himself what he would want.

Now, coming back to the pressure sores, especially around the sacral/anal area that is a real concern because if a colostomy is the only way to keep the sacral area clean and then have the flap done, which is a surgical repair, and then have it heal there, that is a real risk. A colostomy is not a straightforward operation from my experience, and it requires the bowels be attached more or less to the abdominal wall so that fecal matter can come out of the bowels into a bag, again, to keep the sacral area and the rectum clean. So, it’s certainly complicating matters here, but again, why does this man have pressure sores to begin with? Did he not get enough pressure area care, not enough nursing care?

So, coming back to our client as well. They’re still in shock and in disbelief that they’ve been treated so badly by the hospital and that their uncle is now improving. Now, here is another quick thing about this gentleman having a tracheostomy on the 16th of March. The ICU was adamant that a tracheostomy would not be done without doing a PEG tube simultaneously.

Now, we see that again in the U.S. regularly because when once a patient in the U.S. has a tracheostomy and a PEG tube, they can send them to LTAC. And we are strongly opposed to LTAC. LTACs are the better version of a nursing home. If that patients go from ICU to LTAC and they’re very vulnerable and they end up, again, like I said, it’s a better version of a nursing home. No more than that. We strictly oppose that patients should be in ICU for as long as they need to be weaned off the ventilator. And then they can go to a hospital ward, hospital floor, or if they can’t be weaned at all, they should be going to a service, or they can go to a service like intensivecareathome.com and you can check out intensivecareathome.com.

So, the family is really traumatized with everything that’s happened. Also, the family’s sort of taken aback by the approach that the hospital took. And I said to them not to take things personal and also that unfortunately this is what we deal with, quite frequently here at intensivecarehotline.com. Hospitals, especially intensive care units, are not doing the right things. And that’s why it’s so important that if you have a loved one in intensive care, that you do seek advice day one. So, you can be two steps ahead of the intensive care team because most families are just playing catch up. They have no idea what’s actually really happening without the insider knowledge that we can bring to the table.

So, that is my quick tip for today. It wasn’t that quick now. It’s about 10 minutes, but I hope this video really helps.

Thank you so much for watching.

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] 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 a membership area and via email, and we answer all questions intensive care related.

If you need a medical record review while your loved one is in intensive care, we can help you with that as well. We review medical records for intensive care patients in real time, but also, we review them after intensive care, especially if you need closure. If you have unanswered questions or if you’re suspecting negligence.

Now, 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 or insights you have from this video.

Thanks for watching.

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

Take care.