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Quick Tip for Families in Intensive Care: My Dad’s in ICU with 20% Lung Function on a Ventilator! Can He Have a Tracheostomy and Survive?

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

Today, I have a question from Kat who says:

“Hi Patrik,

My dad was admitted to the ICU and intubated 10 days ago for influenza A with COPD (Chronic Obstructive Pulmonary Disease) and emphysema. We were told they would wean him off sedation on Day 4, but then we were told he wasn’t ready. The ICU doctor said he is about 20% lung function and now saying that a tracheostomy is the next step but have not tried to wean him off sedation or ventilation.

Being trapped in an ICU on the ventilator  to die is my dad’s biggest fear as he saw both of his parents pass away in the ICU. I am looking for options to get him a better quality of life. If he cannot come off the ventilator, I want to be his strongest advocate in receiving the care and treatment he needs, both medically and mentally.”

Well, thank you so much, Kat for sharing your dad’s situation.

So, let’s break this down. If his lung capacity is around 20%, it would be difficult for them to wake him up and wean him off sedation. Picture this, if, for whatever reason, his lung function is at 20%, they would wake him up, there’s two scenarios: (a) He’s trying to breathe himself. If lung function is at 20%, it wouldn’t work, and (b) if he does wake up and the ventilator is doing all the work for him and he can’t breathe himself, it would be extremely uncomfortable, it’s sort of a catch-22. His lung function needs to improve so that they can wake him up and then they can move him away from sedation.

So, the first question here is, why is his lung function at 20%? Does he have ARDS (Acute Respiratory Distress Syndrome)? Does he have emphysema? Does he have COPD? Does he have asthma? What’s leading to him having? Does he have a pneumonia? What is happening for him to have a lung function of 20%? Can it be improved?  If it can’t be improved, then the tracheostomy might be the next step. By the same token, what if his lung function stays at 20%? If his lung function is at 20%, he might be on high PEEP (Positive End-Expiratory Pressure), he might be on high oxygen levels, he might be on high levels of support, which could contraindicate them doing a tracheostomy because it would potentially be unsafe and would be too risky to do surgery. So, those are all questions you should be asking leading up to this.

Now, as far as looking at options, let’s just say he can’t be weaned off the ventilator. Let’s just say he needs a tracheostomy to prolong his life, assuming that’s what you want, assuming that’s what your dad wants. Then, you can look at an option such as Intensive Care at Home , especially since it sounds to me like he’s traumatized by having seen his parents die in the ICU. So, a much better option is to take him home for end-of-life care with Intensive Care at Home  if he can’t come off the ventilator.

But your biggest question here is to find out why is he at 20% lung function? Are there any remedies? Is there any cure for this? Does he potentially need to go on ECMO (Extracorporeal Membrane Oxygenation)? Is he a candidate for a lung transplant? I don’t know, you haven’t shared how old your dad is. Is there any premedical history? You haven’t shared any of it, but I think you should be trying to find that out as quickly as possible what else is happening. Then like I said, for if, God forbid, he needs long-term ventilation, long-term tracheostomy, he can’t be weaned and, God forbid, if his lung function isn’t improving, is home care a better option and have end-of-life care at home or long-term ventilation at home)?

You can find out more information at intensivecareathome.com where we send intensive care nurses into the home for predominantly long-term ventilated adults and children with tracheostomies which includes in some cases, a palliative care and end-of-life care.

Now, quickly coming back before I forget about it. To your dad’s current situation, with the lung function of 20%, have they done a CT (Computed Tomography) scan of the chest? Have they done a chest X-ray? I’m sure they have, at least one or the other, but that’s what I would be honing on.

Once again, the biggest challenge for families in intensive care is simply 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. That once again, it is so important that you get a second opinion. It is so important that you have someone like us here at intensivecarehotline.com to look at the medical records so you can have a second opinion. It is so important that you and I get on a call with the doctors so that I can ask them the right questions.

That’s one of the many reasons we also created a membership for families of critically ill patients in intensive care that you can become a member of if you go to intensivecarehotline.com if you click on the membership link, or you go to intensivecaresupport.org directly. In the membership, we answer all questions intensive care related and you have access to me and my team, 24 hours a day, in the membership area and via email, and again, we answer all questions intensive care related in the membership.

I have worked in critical care for nearly 25 years in three different countries. I have worked as a nurse manager in intensive care for over 5 years. I’ve been consulting and advocating for families in intensive care all over the world since 2013.

You can have a look at our testimonial section. You can have a look at our podcast section and see what our clients say. We have saved lives with our consulting and advocacy, and we are making sure that our clients get best care and treatment. We make sure that intensive care teams are transparent with you and your family. We give you a second opinion by looking at medical records.

I also talk to you and your families directly over the phone, Skype, Zoom, WhatsApp. I talk to you and your families directly, one-on-one consulting and advocacy. I talk to doctors and nurses directly.

I represent you in family meetings with the intensive care teams. I’m there making sure you make informed decisions, you have peace of mind, control, power, and influence, and making sure your loved one gets best care and treatment. I also make sure you have the right strategy dealing with intensive care teams.

99.9% of families is in intensive care have no strategy when dealing with intensive care teams and how could they? It’s such a highly specialized area and no one’s sitting at home thinking, “Oh, I wonder what I do if my parent or my spouse or my whoever goes into ICU next week.” No one’s sitting at home thinking that way, but if you’re here watching this, your loved one is probably in ICU and now you need help, so you’ve come to the right place.

That’s also why we offer medical record reviews in real time so that 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 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 simply send an email to support@intensivecarehotline.com.

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, and comment below what you want to see next, what questions and insights you have.

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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