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Quick Tip for Families in Intensive Care: My Husband is Back in ICU with Tracheostomy After Aspiration Pneumonia, 30% FIO2, PO2 70%, Help! 

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

So, today’s tip is again a question answered from one of our members. We have a membership for families of critically ill patients in intensive care where you can get access to if you go to intensivecarehotline.com and you click on the membership link or go to intensivecaresupport.org directly.

Now, let me read out the question from one of our members who says,

“Hi Patrik and Team,

The nurse states my husband’s ABG was 70% PO2 (partial pressure of oxygen). He aspirated maybe because of secretions. He’s off the ventilator with tracheostomy on 30% FiO2 (Fraction of Inspired Oxygen) and being given antibiotics every 8 hours for secretions, I will check the name of the antibiotics again. His bolus feeding had been resumed since 8 A.M. this morning. What are your thoughts?

But also, he’s got diarrhea now before he went on the bolus feeds, and it was the same feed, nothing new. But I think they deliberately gave him expired feed to put him back in ICU. There are some other family dynamics at play.”

So, this is a client or a member who has their husband in ICU for many months now then later tracheostomy, in and out of ICU, and then going back to step-down ICU, and so forth.

Now, let’s look at our answer.

“Thank you so much for your update.

With regards to the arterial blood gas, 70 PO2 is really good. It’s just about on the threshold. It shouldn’t be any lower than that. 30% of FiO2 and the 70 PO2 is okay. Hopefully with ventilation and the PEEP (Positive End-Expiratory Pressure), the PO2 will improve. You haven’t given us the PCO2 (Partial Pressure of Carbon Dioxide), which would be important to know as well.

Now, your husband will need good chest physiotherapy for the secretions in the lungs to be eliminated and to be mobilized. Nebulization like albuterol, hypertonic saline, and suctioning of these respiratory secretions will help as well. Please ask the respiratory therapist to do these interventions and the ICU nurse, they have expertise in these procedures.

So, the question now is, when was the tube feeding given to your husband? When was it given? Did he aspirate because they gave too much? The challenge with the tube feed is that it can be too much, and patient might throw up, vomit, and aspirate. So, you really need to talk to a dietician and the gastroenterologist and to the nurses to see whether there are residual feeds that can cause aspiration.

The tube feeds need to be given safely. It might work for your husband to give the tube feeds with maybe 50 mls an hour rather than 200 mls bolus every so often because that can cause aspiration.

He also must be sitting up or semi-sitting up at least 30 degrees, head-up position. Don’t feed your husband when he’s lying flat because that is another risk for aspiration. Always has to be sitting up at least 30 degrees.

Also, the nasogastric tube needs to be checked for to be in the right position before feeds are given, whether it’s bolus feeds or a continuous feed. Also, make sure that the nurses are doing their hand washing procedures to prevent the spread of infections. Again, check the tubes out prior to feeding and once confirmed, then the feeds can be attached whether that’s bolus feeds or continuously can also be given via gravity. When the feeds are completed, the tube needs to be flushed with water or even sterile warm water and close the tube.

So, you could also attach the tube to a bag, but then maybe there’s going to be reflux and then, he won’t get any nutrition. So really, the best-case scenario is to block the tube after feeds and water have been given and then check whether your husband is digesting the feeds. But if he’s aspirating feeds, there could be a digestion issue, but it will take time probably a few days to work out how to keep it safely so that your husband doesn’t aspirate.

So, it’s good to know that your husband is off the ventilator. That is really good news. I said your husband is on the ventilator, but that was my mistake. He’s actually off the ventilator, on 30% of oxygen through the tracheostomy.

What happens if they take oxygen off? What happens with his saturation? Does your husband have breathing difficulties? Is his respiratory rate high? If your husband improves with his oxygen saturation, the oxygen of 30% can gradually be reduced, provided that your husband can tolerate the weaning off the oxygen doesn’t demonstrate a high breathing rate.

The respiratory therapist, the ICU nurse, and the ICU doctors are the right people to do this assessment. They have to assess your husband’s condition and tolerance prior to weaning off the oxygen, off the tracheostomy, and the oxygen saturation should be at least 94% and above.

So, then what is the cause of his diarrhea? Could be the bolus feed? But I doubt it. If he’s on antibiotics, that might be the reason of the diarrhea. Also, has he been screened for c-diff for a gastro infection?

So then, antibiotic therapy will help your husband with his diarrhea, aspiration, and infections. We really hope and pray for your husband to get better. Also, is your husband alert and responsive to you? Does he smile and try to talk to you? That would be really important to know.

Now, thank you for your email and we welcome your future questions.”

Now, if you have a loved one in intensive care and you want to ask similar questions and you get all the answers from us and help you with managing intensive care teams, making sure you have a second opinion, you can get access to our membership for families of critically patients in intensive care at intensivecarehotline.com by clicking on the membership link or you can 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.

Also, I offer one-on-one consulting and advocacy for families in intensive care, over the phone, via Skype, via Zoom, via WhatsApp, whichever medium works best for you. I talk to doctors and nurses directly. I ask all the questions you haven’t even considered asking, but you must ask so that you can make informed decisions, have peace of mind, control, power, and influence.

I also represent you in family meetings with intensive care teams so once again, that you can see the dynamic shift in your favor. Yesterday, I was in a family meeting with a client in intensive care and the intensive care team realized, “Well, the family finally has someone on their team that understands intensive care inside out just as much as they do.” I’ll do the same for you, making sure you can make informed decisions, have peace of mind, control, power, and influence.

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, and I have been advocating and consulting for families in intensive care for the last 10 years, all over the world.

We also offer medical record reviews in intensive care in real time if you want the 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.

Now, for any of it, 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] with your questions.

If you like my video, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, comment below what you want to see next or what questions and insights you have, share the video with your friends and families.

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.