Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

Quick Tip for Families in Intensive Care: Is it a Good Sign that My Dad is Coming off Vasopressors Whilst on Dialysis in Intensive Care?

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

So today I want to answer another question from one of our members. We have a membership for families of critically ill patients in intensive care. And I just want to read out one of the questions from one of our members and what you get when you are a member of our membership, the value we are providing.

So I’ll just read out a question from one of our members who has her father in intensive care for a long time now.

So one of her questions this week was;

Hi, Patrik and Team,

My dad finally went down on the vasopressors. He was at 30 micrograms of Levophed at 10 p.m. and now at 6:30 p.m. he’s at 12 micrograms. So that’s a significant decrease.

The vasopressin is still at 0.03 units. The “dirty water mag” on the CRRT (Continuous Renal Replacement Therapy), machine is very full and I can see the weight coming off my dad. According to his chart, he gained about 58 lbs this week, his creatinine and BUN (blood urea nitrogen) levels also came down, since he started the CRRT at 8 p.m. last night. CRRT stands for Continuous Renal Replacement Therapy, also known as hemofiltration.

My dad’s body temperature was very low and they said that it was because of the dialysis. It went to 91 to 93 °F. The nephrologist said it would take days for us to see a change in his lab work after starting the dialysis. But I see a big change already. Isn’t that a good sign? They said my dad’s blood pressure would dip on the CRRT, but they were able to actually reduce the vasopressor. How did that happen? And isn’t that a good sign?

Now, here is our response.

Thank you for your update. It is good to see the creatinine and BUN levels are decreasing on the first therapy of dialysis/ hemofiltration. This is definitely good news.

More wastes and fluids were removed from the body as seen by improved creatinine and BUN levels. Reducing the vasopressor while on CRRT/ dialysis is also good. It means that your dad is responding well to the treatment that initiating the reduction of life support such as vasopressors is actually possible.

Maybe during the CRRT, your dad was able to maintain stable vital signs, especially the heart rate and blood pressure, not showing further complications, and lowering the pressors is safe to do so. Furthermore, the temperature going down during CRRT is not unusual because when blood is being filtered through the CRRT machine, you’re basically extracting around 300 mls of blood continuously from the body going through the CRRT machine. And even though there’s a blood warmer in there, the temperature tends to go down because blood is running externally and it being cooled down automatically.

So that also has a risk of masking a temperature. If you’re putting someone on a CRRT machine, maybe with 104 °F or, you 38 °C. And you’re running a CRRT machine, the temperature is usually going down.

And if anything, patients actually get cold and when they get cold, you got to warm them up, of course, got to go to the other end and they might still have an infection and you and it’s being masked. But it is a very, very good sign that they are able to wean off the pressors while your dad is on the CRRT machine. Usually, it’s the other way around.

Someone might not be on the pressors when they go on the CRRT machine and then they need to be started on pressors because once again, you’re removing fluids, you’re removing waste and you’re having blood being taken out of the body run through a machine and that in and of itself often lower blood pressure. So that’s a really good sign that your dad is making progress on that end.

And if his BUN levels and creatinine are improving and he also starts making spontaneous urine, then he has a really good chance of getting off that CRRT machine very, very soon. And also if he stays hemodynamically stable, of course.

So I hope that helps answer your question.

Now, once again, if you want to become a member and want your questions answered in much detail, when you have a loved one in intensive care, go to intensivecarehotline.com and to intensivecaresupport.org. There, you get access to our membership for families of critically ill patients in intensive care. 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. 

I also offer one-on-one consulting and advocacy over the phone via Skype, Zoom, WhatsApp, whichever medium works best for you. And I also talk to doctors and nurses directly asking all the questions that you haven’t even considered asking but you must be asking. If you want to have peace of mind, control, power and influence and most of all if you want to make informed decisions.

Furthermore, I also represent you in family meetings with the intensive care team. I have been in numerous family meetings over the phone via Zoom, via teams, on many mediums and many platforms and representing you in family meetings with intensive getting, making sure you’ve got a strong advocate on your team, making sure you get the best care and treatment options for your loved one. Making sure you are well educated on your rights as a family in intensive care so that you always get the best care and treatment for your critically ill loved one.

We also offer medical record reviews in real-time so that you can get a second opinion in real time. And just as an FYI, you are well entitled to access your loved one’s medical record assuming you are the power of attorney. And we also offer medical record reviews after intensive care if you have unanswered questions if you need a closure or if you are simply suspecting medical negligence.

Now and all of that, once again, you get at 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.

Now, if you’re finding my videos valuable, 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 and share the video with your friends and families.

Thank you so much for watching.

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

Take care for now.

Related Articles:

Quick Tip for Families in Intensive Care: Weaning off VA ECMO and VV ECMO Simultaneously? Quick Tip for Families in ICU: Extubation, Tracheostomy or Hospice? What is Best for My Loved One? Quick Tip for Families in ICU: The Difference Between “Ending Suffering” and Continuing Treatment! Quick Tip for Families in ICU: My Wife’s in ICU with Cardiac Arrest & Tracheostomy, Can I Make Decisions? Quick Tip for Families in Intensive Care: My 28-year-old Husband had a Liver Stab Wound & His Heart Stopped! ICU Wants to Stop Treatment, Help!