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

Today, I have an email from Belinda who says,

“Hi Patrik,

My dad is 88. He’s developed pneumonia in ICU after surgery and being in bed for two weeks. They want to take out the tube that is helping him breathe and do a tracheostomy. He underwent two surgeries for broken bones on the left hip and left elbow.

Before intubation, I was told it was to help him breathe better and they were going to look into his lungs and to see what was happening. If it was pneumonia, it could be treated with antibiotics. Now, because he has had episodes where he’s not able to expel the mucus, his breathing becomes very labored, and his air doesn’t reach his major organs according to them.

I don’t know right now the numbers, but can you ask for me with a second opinion?”

For sure. This is from Belinda. Now, Belinda, thank you for sharing your dad’s difficult situation with us.

So, it is very difficult when the older the patient is and is on a ventilator and can’t be weaned, the more difficult it is to get them off the ventilator, that’s for sure. But at the same token, I’ve seen plenty of patients in my lifetime to come off the ventilator irregardless of their age.

I am a critical care nurse by background, having worked in critical care nursing for nearly 25 years in three different countries where I worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care here at intensivecarehotline.com since 2013. I can confidently say we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com or you can verify it on our intensivecarehotline.com podcast section at intensivecarehotline.com.

So, helping you here, Belinda, if the pneumonia is a bacterial pneumonia, they can just do a sputum sample, send a sputum sample, isolate the bacteria, and then give the right antibiotic. It’s a very targeted effort. If it turns out that the pneumonia is not bacterial, but it is either viral or it is fungal, then he needs to have the right antivirals or antifungal medication.

So, he had episode where he’s not able to expel the mucus, his breathing becomes very labored. The problem here is that when someone is having a breathing tube in the throat and they can’t bring up their sputum, they need to be suctioned with a suction catheter, and especially when patients are in an induced coma, which is what your dad is in from your email. He’s on sedatives, he’s on opiates, which means his coughing will be inhibited because he’s sedated and he’s on opiates. Opiates in particular, have as a side effect respiratory depression. So, he’s not reaching any.

If he is full of mucus, he needs lots of suctioning, yes, that would potentially put his oxygen levels down and that would potentially put his breathing and his oxygen delivery to major organs at risk. That then in retrospect, puts him at risk of kidney impairment or kidney failure even, liver impairment or liver failure even. Same with the heart, so it’s a risk of potentially a heart attack. So, there’s many, many risks here that if his oxygenation is inadequate because of labored breathing or because of too much mucus on his secretions, that there’s other organ damage following from that.

What’s the solution here? Depending on what the chest X ray shows, if he’s very congested, he might benefit from a bronchoscopy and sucking out all the mucus, but he may simply benefit from getting woken up. Get him out of the induced coma, take sedation away, take opiates away, and then let him wake up and then he might be in a stronger position to cough up the secretions.

A lot of it also comes down here now to arterial blood gases. What are his arterial blood gases like? What’s his PO2 (partial pressure of oxygen)? What’s his CO2 (partial pressure of carbon dioxide)? What’s his PH in particular? Those are all questions that you need to ask in a situation like that.

Once the X-ray or the lungs are cleared, once the pneumonia is healed, that’s also bringing your dad in a much better position to wake up to wean off the ventilator, and that also should minimize any other organ damage. So, it is really important at the moment that mechanical ventilation is being optimized for your dad. That is really important to optimize mechanical ventilation and clear all the mucus from his chest and once again, you can do that by suctioning or by doing a bronchoscopy, which requires some general anesthetics as well.

Other things that you should be looking for in a situation like that is, is your dad getting inotropes or vasopressors? Is he hemodynamically stable? Is his blood pressure within normal limits? Because if they’re not, that could also suggest that he might be septic or that he’s simply too sedated. By the same token, because he had some fractures, he might need a level of opiates just to control the pain. So, there’s a number of factors here that come into play that need to be looked at in much detail.

But it would be really good to look at the medical records or it would be good for me to talk to the doctors and nurses directly and ask a series of questions that would get us closer to what’s really happening because there are things like, “I don’t have any blood results. I don’t have any arterial blood gases, I don’t have any chest X-rays, can’t see the sputum sample results and so forth.”

So, I hope that helps you.

Because we get so many questions from families in intensive care and we’ve also helped hundreds of clients over the years, including hundreds of members in our membership. We have a membership for families of critically ill patients in intensive care and you can become a member if you go to intensivecarehotline.com if you click on the membership link or you go to intensivecaresupport.org directly. In the membership, 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. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. Those eBooks and videos as well as the access to me and my team will help you to make informed decisions, have peace of mind, control, power, and influence so that you can influence decision making fast so that your loved one gets best care and treatment while they’re critically ill in intensive care.

I also do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, Skype, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply can’t afford to get wrong. I also talk to doctors and nurses directly and I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected] with your questions.

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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.

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