Intensive Care Hotline

is instantly improving the lives for Families of critically ill Patients in Intensive Care, so that they can make informed decisions, have PEACE OF MIND, control, power and influence and therefore stay in control of their Family's and their critically ill loved one's destiny

Contact Intensive Care Hotline
24/7 Phone Access
Need Instant Help? Call Now or... Make an Appointment

YOUR INTENSIVE CARE HOTLINE - Quick Tip for Families in Intensive Care: My Sister’s Been on ECMO for 5 Days for Pneumonia. Weaning Her Sedation Didn’t Work, Is This Normal?

/ Patrik Hutzel - Critical Care Nurse Consultant / No Comments

Quick Tip for Families in Intensive Care: My Sister’s Been on ECMO for 5 Days for Pneumonia. Weaning Her Sedation Didn’t Work, Is This Normal?

Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

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

So, I had an email from Amanda this week who says, “My sister has been placed on ECMO for pneumonia. She’s currently been receiving treatment ECMO for 5 days. They tried to wean her sedation yesterday, but her saturations and respiratory rate have dropped. Is this normal? Will she be strong enough to come off?” What a great question. So, if she has pneumonia and she had to go on ECMO, it must be a very severe pneumonia.

Basically, for anyone that wonders what ECMO stands for and what it does, ECMO stands for Extracorporeal membrane oxygenation. It’s basically a bypass machine and an ECMO machine can take over the function of the heart or the lung for a period of time so that the lungs, in this situation, for pneumonia have time to recover.

So basically what happens during ECMO is, the lung function is taken over by a machine. Carbon dioxide is getting removed from the machine and oxygen is being given back into the body from the machine through big cannulas that take blood out of the body and put oxygenated blood back into the body, that’s basically the principle of ECMO.

Now, if she’s been on ECMO for 5 days, that’s not an extremely long time, whether that’s enough for your sister to have her lungs recovered, I don’t know. Subsequent chest x-rays will show that, subsequent arterial blood gases will show that, and oxygen saturations will show that.

Unlike you’ve said, they weaned her sedation, but her saturations and respiratory rate dropped. So, what they might have done simultaneously as they were switching off sedation, they were probably looking at whether ECMO support can be removed and can be reduced. That means a patient has to do more work of breathing themselves. So, they might have reduced the sedation, they might have reduced ECMO support, try to get her to do more work herself, more breathing herself, and maybe that’s why her saturation dropped.

If her respiratory rate dropped, that doesn’t quite make sense. I’ll tell you why it doesn’t quite make sense. If someone is struggling to breathe, most of the time, they are breathing very fast to compensate for a low oxygen saturation. So, you are saying your sister’s respiratory rate has dropped as well, not quite sure what to make out of that. But it might have happened because especially if she’s also still on opiates such as morphine or fentanyl. One of the main side effects is respiratory depression, i.e., respiratory rate goes down.

You’re also asking, “Is this normal?”, it is normal that you want to wean someone off ECMO, and it is normal that you want to wean someone off sedation. Everything else could be detrimental to a patient. So, that’s a good sign.

It’s not a good sign that saturations dropped but again, maybe she’s just not quite ready and there’s going to be a process where you need to always try weaning off sedation, see whether someone is waking up, if chest x-ray, for example, has been good, if arterial blood gas has been good. You want to wake someone up, get them to do more breathing themselves and then it’s working or it’s not working, then you got to reset that. It can be a bit of a struggle and it can take time to achieve the end goal to get someone off ECMO, get someone off sedation, and get someone extubated. So can be a long process, but you got to keep trying.

We should be strong enough to get off ECMO. Well, the longer someone is in an induced coma, the more they are deconditioning, and their muscles are wasted. So, therefore, every day she’s on sedation and in an induced coma and on ECMO, she will probably get weaker. So, it’s to a degree, a race against time, so that she can come off the ventilator, that she can be strong enough to breathe by herself.

So, that’s where she is at by what you have shared with me, and hopefully in the next few days while she’s probably also getting antibiotics, antivirals, and antifungals, depending on what pneumonia she has, and as they hopefully can wean her off and then, let her do more and more of the breathing herself.

While she is still intubated, it’s also important to note here that many patients on ECMO are also intubated. Then, as you reduce ECMO support, you then slowly bring back the ventilator and you’re trying to reduce ventilator support as well. So, it’s a bit of an art rather and the science to get someone out of this coma, especially on ECMO. So, be patient, let them keep trying, and if you have questions, keep coming back to us here.

Now, if you have a loved one in intensive care, go to 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.

I also offer one-on-one consulting advocacy over the phone, via Zoom, via Skype, via WhatsApp whichever mode works best for you. I talk to doctors and nurses directly, if you want me to do that. I can represent you in family meetings. I’ve done this for hundreds of clients, representing families in intensive care, family meetings, and asking the questions that you haven’t even considered asking.

Now, if you need a medical record review in real time in intensive care, please contact us. We’ll give you a second opinion and a medical record review in real time. If you need a medical record review after intensive care if you’re suspecting medical negligence, if you need closure, or if you have simply unanswered questions, please contact us as well.

Now, if you find value in these videos, subscribe to my YouTube channel, click the like button, click the notification bell, share this video far and wide 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.

 

BOOK YOUR FREE 15-MINUTE CONSULTATION NOW!

Related Articles:

Default ThumbnailQuick Tip for Families in ICU: You Were Absolutely Right, LTAC is a Complete Waste of Time After ICU! Default ThumbnailQuick Tip for Families in ICU: How to Avoid Euthanasia in ICU After Tracheostomy! Default ThumbnailQuick tip for families in ICU: Two steps forward one step back when your loved one is in ICU! (Part 2) Default ThumbnailQuick Tip for Families in ICU: Should You Stop Treatment if Your Loved One’s in Multi Organ Failure? Default ThumbnailQuick Tip for Families in ICU: Should your Loved One Go from ICU to LTAC with Multiple Comorbidities?