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 yesterday, I was talking to a client who has their 78-year-old father in ICU with multiple complications after pneumonia and sepsis. And of course, the intensive care is trying to push the family to end of life and palliative care for their father, even though their father is not even on a ventilator.

But for lack of a better term, the palliative care team is breathing down the family’s neck saying, “Well, it would be in the “best interest” for their father to die.” The family is smart enough to look through the agenda of the ICU to empty their beds and said, “Well, we don’t want to talk about that. We want to talk about the treatment of our father, and we want to talk about how to get him out of intensive care as quickly as possible.”

The situation is that he was intubated for four days, and he was on BIPAP for a few more days. Now he’s off BIPAP, but he’s on high-flow nasal prong oxygen at about 50%. He’s got diabetes, insulin-dependent. He’s got a history of heart failure. He’s got a history of atrial fibrillation. He’s got a history of kidney failure. So, there’s a fair bit going on.

He’s also got a history of sleep apnea at home. He is on a CPAP machine which they pretty much stopped now. They realize that after they stopped the BIPAP that he’s getting more and more confused, getting more and more agitated. They stopped the Precedex, started him on some Ativan now. But I believe one crucial factor that’s potentially contributing to his confusion and agitation is not getting him the CPAP and the BiPAP because his baseline CO2 (Carbon Dioxide), is probably pretty high with sleep apnea. And if they stop the BIPAP now, his CO2 would be going up and therefore, he’d probably be confused and agitated. So, my recommendation was to reconsider the BIPAP (Bi-level Positive Airway Pressure) and the CPAP (Continuous Positive Airway Pressure).

The other issue here is that they haven’t been feeding him for three days for no apparent reason. He’s got a nasogastric tube in situ, and they want to push him towards the PEG (Percutaneous Endoscopic Gastrostomy).  And again, we recommended not to move towards the PEG. He can have feeds through a nasogastric tube, or he can have feeds via TPN (Total Parenteral Nutrition).

So, it seems to be apparent more and more that when we’re working with clients, that ICUs seem to be withholding nutrition at times to push families on the agenda of withdrawing life support and letting people die. If you’re not feeding someone, yes, they’re potentially going to die. And you can’t fight a critical illness without nutrition. There’s enough research out there that confirms that early feeding in intensive care helps to combat critical illnesses.

So, we’ve educated the family there, and if they were to give consent to a PEG tube, chances are they would be sending their father on to a nursing home as quickly as possible because a PEG tube makes it really easy for nursing homes to deal with nutrition. They don’t have to feed patients, and it has this perception of permanency.

Whereas a nasogastric tube, you can do the very same than a PEG tube. You can give nutrition, but it’s temporary and people have to start eating and drinking again. Now, the issue here also is that their father can’t swallow at the moment and he’s not coughing. So, those are issues that need to be resolved. There has been no confirmation of a stroke, but also it hasn’t been properly investigated either.

But for now, they need to stand their ground. Look at the best care and treatment options. Get a neurologist involved, see whether he’s had a stroke, God forbid, but also get him back on some BIPAP or on some CPAP to get the CO2 down and see whether his neurological condition, his drowsiness, and agitation will improve. Then hopefully, he can move on, move to a ward, and go home as soon as possible rather than looking at the end of life. It’s very disappointing that ICUs keep doing that rather than looking at optimizing quality of life.

So, that is my quick tip for today.

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 the membership area and via email and we answer all questions intensive care related.

If you need a medical record review and a second opinion in real time, please contact us as well. We review medical records in real-time and give you a second opinion, but also by talking to doctors and nurses directly. We give you a second opinion in real time, often within less than 24 hours. If you need a medical record review after intensive care, especially if you have unanswered questions, if you need closure, or if you are suspecting medical negligence, please contact us as well.

Like the video, subscribe to my YouTube channel for regular updates for families in intensive care, 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’ll talk to you in a few days.

Take care.

Related Articles:

Quick Tip for Families in ICU: When Do You Need to Start your Research if Your Loved One is in ICU? Quick Tip for Families in Intensive Care: Dad is in ICU Psychosis and ICU Delirium, How do We Get Him Out of the Delirium? Quick Tip for Families in ICU: What Happens with My Husband in ICU After a Heart Attack? Quick Tip for Families in Intensive Care: What are Alternatives to a Tracheostomy? Quick Tip for Families in ICU: My Husband Has Survived a Diabetic Coma and is Now Not Waking Up in ICU, Is This Normal?