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 is a question that I had from Tom and Tom writes, “My mom has been in intensive care for almost two days. I was getting readings at home in the 90s, but two years after an episode of CHF, which stands for Congestive Heart Failure, and a two-week hospitalization, but she came home with no oxygen. Suddenly, the readings were in the 80s and Monday morning in the 70s. I called 911 and in emergency, she dropped down, her oxygen saturations to 47%. She is now on BIPAP (bilevel positive airway pressure), and they have dropped her from FiO2 of 80% to 40% but when they try to put her on oxygen with the bag, she fails. My mom is 94 and wants to live, please advise.”

Now, I suggest your mom has developed some form of pneumonia. You haven’t shared anything about what the chest x-ray looks like and what her official diagnosis is, which leads me to what I’m saying over and over again that the biggest challenge for families in intensive care is 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.

Either way, one of your first steps is to get the exact diagnosis of your mom, get access to the medical records, and then we can give you a second opinion. But what I can advise you on, first and foremost, I must assume that with her Congestive Heart Failure, she has gone into some form of pulmonary edema and/or potentially developed some form of pneumonia. So, I would think they’ve started her on some antibiotics. Maybe she is on inotropes or vasopressors, maybe she is hemodynamically unstable.

Now, the goal for your mom, under any circumstances, is to keep her off the ventilator and the breathing tube. You do not want her to be intubated. So, what needs to happen is mobilization, probably keep the BIPAP on for as long as possible. It all depends on the chest x-ray.

When someone has a pneumonia or pulmonary edema, there could be atelectasis developing which is a collapse of the lungs. Now, the BIPAP is really good to open up those partially collapsed lungs and the longer she can tolerate the BIPAP, the higher chances that she can clear the pneumonia.

Now, there is always a risk, especially on BIPAP, there’s always an aspiration risk. So, what that means is when someone is on BIPAP, it’s a lot of pressure going into the lungs, but also going into the stomach. So, when your mom is supposedly eating or drinking, I’m not sure whether she can do that at the moment, there is an aspiration risk which then would inevitably get her intubated and in an induced coma and get her ventilated. So, keeping her little by mouth might help, but then she won’t have the strength and the stamina to fight the infection.

So, what’s the solution here? One of the solutions might be TPN (Total Parenteral Nutrition), also known as intravenous nutrition. That might be one solution because research has shown that the sooner you can start feeding someone in intensive care, the better their chances for recovery.

Again, comes back to the biggest challenge for families in intensive care that they don’t know what they don’t know. You haven’t considered in your email. What about nutrition? What about the risk of aspiration? What about mobilization? But obviously, I’m here to advise you that these are the things that need to happen.

Also, ask for blood results. What’s a white cell count like? Does she have a temperature? Is she clearing the infection? Once again, what do chest x-rays look like? Furthermore, what are her arterial blood gases? And last but not least, what BIPAP settings is she on? You mentioned she’s on 40% of FiO2 and she’s been reduced from 80% FiO2. That’s really good. But what other settings is she on? What’s her IPAP (inspiratory positive airway pressure)? What’s her EPAP (expiratory positive airway pressure)?

So again, it’s highly specialized knowledge that you only understand if you’ve worked in intensive care for decades like I have, but it’s critical because the devil is in the detail.

Also, what you should consider is take her home. If she can’t be weaned off the BIPAP, take her home on the BIPAP. I’m sure you would want her at home, look at intensivecareathome.com.  With Intensive Care at Home, we are operating all around Australia for predominantly long-term intensive care patients that have a tracheostomy, have a ventilator, but also for BIPAP and CPAP ventilation, especially if it’s ongoing, which for your mom, it may be. So, go to intensivecareathome.com for more information. So, I hope that helps, Tom.

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 and Intensive Care at Home related.

Also, we review medical records in ICU and give you a second opinion in real time. So go and contact us if you want a second opinion in real time and a medical record review in real in real time. We also review medical records after intensive care if you have unanswered questions, if you are looking for closure, or if you are simply suspecting medical negligence.

Again, if you have a loved one in intensive care, long-term, please go to intensivecareathome.com and contact us on one of the numbers on the top of our websites or end us an email to [email protected]. Currently, we are working all around Australia and we are also opening up in the U.S. Please, contact us if you’re in Australia or in the U.S.

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 and insights you have from this video.

Thanks for watching.

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

Take care for now.