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If you want to know what treatment is needed for someone on a ventilator in ICU with lung cancer cells, pleural effusion, and bile that continues to come out of his body, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecarehotline.com and I have another quick tip for families in intensive care.

So today, I have an email from Tammy who says,

“Hi Patrik,                                                                        

My husband is 61 years of age, he’s on a ventilator in ICU. He’s got lung cancer cells, he’s got pleural effusion, and he’s got bile coming out of his body. What treatment would you suggest?”

Now, Tammy, I’m very sorry that you’re facing this and I’ll certainly provide you with some helpful information here. Based on your description, your husband’s treatment will depend on the severity of his condition, his overall health, and the goals of his care.

Here are some considerations for managing his situation. Number one, he’s on ventilator support. If your husband is on a ventilator, it means his lungs are not functioning properly and well enough to sustain breathing on their own. Ventilator support will continue to provide oxygen and remove carbon dioxide and the medical team and the nursing team will assess whether ventilator support is temporary or long-term and discuss options including tracheostomy, potentially, or if depending on the goals of care for your husband, what he wants and what you want, if palliative care is an option, or if weaning off the ventilator is possible or isn’t possible.

Next, because he’s got lung cancer and the pleural effusion, lung cancer can cause pleural effusion by fluid buildup in the chest cavity. Cancer cells are in the fluid, it is called malignant pleural effusion. Treatment focuses on relieving symptoms and controlling fluid buildup. One way to treat is thoracentesis, draining fluid from the pleural space using a needle. Indwelling pleural catheter, a catheter may be placed to allow ongoing fluid drainage. Pleurodesis, a procedure to prevent fluid from reaccumulating by sealing the pleural space. Cancer treatment, if appropriate, chemotherapy, immunotherapy or targeted therapy might be used to slow cancer progression and reduce fluid buildup.

Next, the bile leakage. Bile coming out of the body could indicate complications such as a biliary obstruction, fistula or damage to the liver, or gastrointestinal system. Management may involve a drainage, biliary drain or stent may already be in place to manage the bile leakage. Surgery, in some cases, surgical intervention may be considered if repair is possible. Medications, supportive medications to manage symptoms including nausea, bile acid, sequestrants, and antibiotics if there’s an infection.

Symptom management and palliative care. If the focus is on comfort rather than curative treatment, palliative care will aim to manage symptoms like pain, shortness of breath, nausea, fatigue, and anxiety.

Medications and interventions will be adjusted to improve its quality of life. When it comes to pain management, in particular, you got to look at opiates such as morphine, fentanyl, for example.

Then nutritional support, if bile is leaking and digestion is impaired, your husband may require enteral nutrition, such as feeding via nasogastric tube or PEG (Percutaneous Endoscopic Gastrotomy) tube or parenteral nutrition, IV nutrition if the gastrointestinal system cannot process food such as TPN (Total Parenteral Nutrition).

Also, emotional and practical support. A multidisciplinary team, including oncologists, pulmonologists, palliative care specialists, social workers, ICU teams, doctors, nurses, will work with you to plan the next steps if transitioning to hospice care is something you would consider. They can provide that for you.

Questions to ask your husband’s doctors, what are the goals of treatment, extending life, relieving symptoms or combination? But I go like, you need to ask your husband what he wants. What options are available to manage the pleural effusion and bile leakage? Are there treatments for the cancer that can help reduce these complications? What can we do to prepare for care, potentially at home, or end of life care, if needed, or what curative treatment options are out there?

It is an extremely complex and emotional journey. The medical team should guide you through making decisions that prioritizes your husband’s comfort, dignity, but also curative chances if there are any.

But also, for example, what about ventilation weaning? Is that a possibility? Those are questions you need to ask as well. Is cancer treatment possible? Is then weaning off the ventilator possibility, getting him out of the induced coma? So, those are questions you need to consider.

Also, once the pleural effusion is drained, will that help to wean him off the ventilator? And is a tracheostomy an option? You haven’t shared whether your husband already has a tracheostomy potentially. There are many unknowns here, and it would be incredibly valuable if you had access to the medical records so we can look at the medical records.

Now, I have worked in critical care nursing for 25 years in 3 different countries, where I worked as a nurse manager for over 5 years in critical care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy here at intensivecarehotline.com. You can verify that if you go to intensivecarehotline.com, if you look at the testimonial section, click on the testimonial section, or if you click on the podcast section where we have done some client interviews who can verify that we have saved their loved one’s lives in our consulting and advocacy. We can do the same for you here, Tammy, making sure your husband gets best care and treatment always.

That’s why we have helped hundreds and hundreds of members and clients over the years to improve their lives instantly and save some of their loved ones’ lives. That is what we do, we solve problems for families in intensive care.

That’s why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. When I talk to you and your families directly, I also talk to doctors and nurses directly with you or on your behalf. I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. I also represent you in family meetings with intensive care teams.

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

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, 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. In the membership, you also have exclusive access to 21 e-books and 21 videos that I have personally written and recorded. All of that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always.

All of that, you get 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.

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, comment below what you want to see next, what questions and insights you have from this video, share this video with your friends and families.

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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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