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Quick Tip for Families in Intensive Care: My Brother in Law’s in ICU with Pneumonia & Induced Coma, Now in Kidney Failure & Dialysis, Is this Normal? 

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

So today, I’ve got a question from Jane, “My brother-in-law was admitted to ICU with infection in both lungs, pneumonia from influenza A, and had to be put into an induced coma. A few hours passed and they’ve said that his kidneys are failing and has been given dialysis. How has this happened? Is this a bad sign? From Jane.” Thank you, Jane, for your question.

So, just for context, when patients are induced into a coma that also means they are automatically intubated, and they’re put on a ventilator with a breathing tube in their mouth most of the time. I presume that is what’s happened in your brother-in-law’s situation because of the pneumonia.

He would have had some respiratory deterioration, probably Type 1 respiratory failure with low oxygen levels, poor arterial blood gases, and probably a very compromised chest x-ray, and that would have indicated to the intensive care team he needs intubation and needs to be put into an induced coma.

Now, with the infection in the lungs, the pneumonia, there could have also been signs of sepsis or septic shock. Now, what happens during sepsis or septic shock is that blood pressure plummets, drops significantly, and a patient then needs inotropes or vasopressors or fluid resuscitation or a combination of both to maintain a blood pressure that is (A), compatible with life and (B), provides sufficient kidney perfusion.

So, when patients have a severe infection in intensive care, again, blood pressure drops significantly to a life-threatening level. Therefore, kidney perfusion, i.e., blood flowing to the kidney is much reduced or stops completely and that gets kidneys into acute kidney failure.

So, it’s a common occurrence in ICU for patients who have severe infections. But all the other issues even after trauma, there is a condition called like rhabdomyolysis. There are other conditions that lead to kidney failure in intensive care.

Now, your brother-in-law is given dialysis so that means they’re doing all the right things to remedy the kidney failure. So, they’re doing all the right things from what I can read from your email.

How has this happened? I just explained that to you how it most likely happened. Is it a bad sign? Look, you don’t want your brother-in-law going into kidney failure. But again, it’s a common occurrence in intensive care for critically ill patients so it is not out of the ordinary, unfortunately. It’ll probably be, you need to monitor this over the next few days. See whether the dialysis is getting the kidneys back on track.  It should ideally do that.

It’s also a case of, can your brother-in-law tolerate dialysis, or does he potentially need hemofiltration? There are two forms of remedy for treatment for kidney failure in intensive care. If drug treatment such as furosemide and Lasix isn’t working, then patients are offered dialysis or hemofiltration.

Dialysis basically means a patient gets kidney filtration for 3 to 4 hours, sharp, short onset with high volumes of fluid removal where hemofiltration is often over 24, 48, and 72 hours, and the fluid removal happens that much, much slower. Instead of removing 1500 to 2000 mls over a 4-hour period, the fluid removal might be 100 mls per hour over 24, 48, or 72 hours. So, it’s a much more gentle approach.

In both cases, blood pressure might drop. In both cases, volume might need to be replaced with blood transfusions or inotropes or vasopressors need to be given to sustain a blood pressure that is compatible with life and also perfuse the kidneys. So, I hope that helps and explains the situation for you, Jane.

If you have a loved one in intensive care and you need help, contact us 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.

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.

Also, I offer one-to-one consulting and advocacy over the phone, via Skype, via Zoom, on WhatsApp, or whichever medium works best for you. I represent you in family meetings with the doctors and the nurses. I talked to doctors and nurses directly on your behalf with you. I’m asking all the questions you haven’t even considered asking that are absolutely critical for you to have peace of mind, control, power, and influence and more importantly, so that you can make informed decisions. You need a second opinion in order to make informed decisions while you have a loved one in intensive care.

Part of that second opinion is we also review medical records in real time so you can have 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 simply suspecting medical negligence.

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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.