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

So, today’s tip is again about one of our members having questions and we answer them as part of our membership for families of critically ill patients in intensive care where you can get access to at intensivecaresupport.org. Go and check it out.

So, one of our members writes in, “Hi, Patrik and team. My dad is doing a lot better in a lot of ways, but he is still recovering. His urine output has gotten a lot better. They haven’t done dialysis in 4 to 5 days. Technically, they did dialysis this morning, but they explained that it was for the purpose of removing any potential toxins from Dad’s body, cleaning the blood, and not to remove fluids. They didn’t remove any fluids today.

This is the second time they have given him a nasogastric tube and the fourth time they said he has an ‘ileus’. Ileus stands for bowel obstruction. His stomach was hard and distended so they put the nasogastric tube in to remove the contents of his stomach and did the dialysis to remove any toxins and that may be in his body due to the ileus. I don’t understand why he’s having this issue. He has never had any serious problems with his digestive tract before.

He was brought to the step-down unit but was there approximately 8 hours before he returned to the ICU. I really don’t like or trust this hospital at all. They’re treating this visit to the ICU as a whole new encounter when really, he should have never been brought to the step-down unit for those 8 hours. Clearly, he wasn’t ready yet.

The minute he got to the step-down unit, they took his vitals. He had a 103 °F temperature so obviously, he had that in the ICU minutes before, but no one checked. He was vomiting in the ICU before they transferred him, and he continued to vomit in the step-down ICU unit. His blood pressure got to 60/40 before they called the emergency response team. He was on pressure support on the ventilator for 24 hours straight until this incident. They are still investigating what caused this when he was doing so much better.

They said the sputum culture is growing a gram-positive rod so they’re covering that with antibiotics. He is on 1 to 3 micrograms per hour of Levophed when he has been off that for a while. He hasn’t been able to wean off the midodrine yet though. He has been talking a lot more and he lost so much of his water weight. There are a lot of positives like his kidneys rebounding the need for less vasopressors. The fact that he was breathing on his own on pressure support. But I am concerned about this ‘ileus’ and why this is happening, why he’s still requiring midodrine, and why he gets so sick suddenly so suddenly the sepsis used to come on slowly and I could easily identify it with enough time to get help. They don’t want to try him off the ventilator until he’s off the pressors, which is a thought that changes based on which doctor decides to speak to me on any given day.

Finally, we got to talk to a cardiologist, and they said that my father’s heart can rebound after the infection clears just like his kidneys. They said they pulled one liter of gastric contents out of his stomach. My thought is why the heck was no one checking for residuals to begin with?”

Wow, there’s a lot going on there and here’s our reply, “Thank you for patiently waiting for our reply. Sending your dad to the step-down ICU while he was still unstable and had unresolved problems was too risky. Again, an ileus is a bowel obstruction, and should definitely not be taken lightly as it can lead to blockage obstruction of the intestine track due to lack of digestive tract movement. I think it might have been overlooked.

Sepsis can be a cause of ileus but also the other way around, ileus can be a cause of sepsis. The inflammatory or stress response of the body in fighting the infection immobilizes the intestines. Some medications such as opiates or sedatives can also slow the movement of the gastrointestinal tract down. Another factor is electrolyte imbalances, low potassium and magnesium, and high calcium can cause ileus. In this particular case, our member’s dad was in an induced coma for a long time, being heavily sedated and on opiates would have caused the gut motility to slow down and therefore might have caused the ileus, not uncommon unfortunately.

In addition, prolonged bed rest, immobility, and bed boundness can slow the metabolism and cause constipation and then lead to ileus. This is why mobilization is so important in ICU to help patients to move the bowels regularly but also to aid recovery.”

You would have heard me talk about mobilization for many years that this needs to happen as quickly as possible in ICU.

“An ileus, generally speaking, is a temporary reaction of the body and can be resolved with aggressive and prompt treatment. Nasogastric tube decompression is needed to remove air and fluids. Fluids and electrolytes replacement should be done through a peripheral IV or through a central line, depending on the nature of the electrolytes.

Regarding the checking of residuals, it is a standard procedure to check for the nasogastric tube residuals prior feeding even if he’s on a continuous feeding pump. 1 liter of gastric content is a lot to be aspirated if checked properly.”

So, the residuals need to be checked every four hours, that’s a standard protocol in most ICUs. So, not sure why they haven’t checked it, but that’s why it’s so important that you obviously keep asking those questions and making sure they’re doing all the right things.

“Vasopressors and midodrine are still present to maintain normal blood pressure and adequate blood supply to the gastrointestinal tract for it to function properly. Decreased blood flow to the gastrointestinal tract can damage the intestinal tissues and possibly lead to cell death just like heart attack to the heart and stroke to the brain.”

There’s also a big risk of gastric perforation, and bowel perforation with an ileus. So, that could lead to peritonitis, that could lead to sepsis, and there’s a high mortality for sepsis, generally speaking.

Keep in mind your dad has been through a lot. We are praying for your dad’s safety and steady recovery. Feel free to send us any updates any time.” So, that was our response to our member.

Now, if you want to become a member, as part of our membership of families of critically ill patients in intensive care and you want to have your questions answered, 24 hours a day, in a membership area and via email and you can get that at intensivecaresupport.org. There, you have access to me and my team, 24 hours a day, in the membership area and via email and we answer all questions, intensive care related.

I also offer one-on-one consulting and advocacy for families in intensive care. I talk to doctors and nurses directly, to social workers, whoever you want me to talk to and you will see that we turn around your situation pretty quickly by bringing in my insights into your situation. I have worked in intensive care for over 20 years in three different countries where I also worked as a nurse unit manager for over five years. So, I have all the insights that you need to turn your situation around, your loved one’s situation around, and making sure you can make informed decisions, get peace of mind, control, power, and influence when your loved one is in intensive care.

I also represent you in family meetings with intensive care teams, again, making sure your loved one gets the best care and treatment so that I can ask all the right questions, making sure I get results for you so that the intensive care team can’t just push their agenda onto you without you knowing what’s happening. Once again, the biggest challenge for families in intensive care is that they don’t know what they don’t know.

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

If you want to engage with me one on one over the phone, via Zoom Skype, WhatsApp, or whichever medium works best for you for the consulting, please contact us at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].

If you like my videos, 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 I will talk to you in a few days.

Take care for now.