My name is Patrik Hutzel from Intensivecarehotline.com and welcome back to another quick tip for families in intensive care. Here at intensivearehotline.com, we instantly improve the lives for families of critically ill patients in intensive care so that you can make informed decisions, have peace of mind, control power, and influence making sure your loved one always gets best care and treatment, even if you’re not a doctor or a nurse in intensive care.

I recently received this question from a reader named Alexis:

“Hi Patrik,  My sister is on BiPAP with Stage 4 colon cancer, fluid on her lungs, blood pressure is low, heart rate is 125. How do I make a decision being the medical POA?  Alexis”

Alexis, thank you so much for reaching out. I can only imagine how frightening and overwhelming this situation must feel right now. You are your sister’s voice when she can’t speak for herself, and that is one of the most important and difficult roles anyone can ever take on.

In this article I want to help you understand exactly what is happening clinically with your sister, what all the treatment options look like, and how you can make an informed decision as her medical Power of Attorney — because you deserve clarity, not confusion.

What Happening Clinically? Understanding Your Sister’s Condition

BiPAP — What It Means and Why It Matters

BiPAP stands for Bi-level Positive Airway Pressure. It is a form of non-invasive ventilation — meaning your sister is receiving respiratory support through a mask, not a breathing tube. The BiPAP machine delivers pressurized air to help open her airways and lungs with every breath, reducing the work her body has to do to breathe.

The fact that your sister needs BiPAP tells me her lungs are struggling significantly. In the context of stage 4 colon cancer with fluid on her lungs, her respiratory system is under serious stress.

Fluid on the Lungs — Pleural Effusion in Stage 4 Colon Cancer

“Fluid on the lungs” in a cancer patient like your sister is most likely a pleural effusion — a build-up of fluid in the space between the lung and the chest wall. In stage 4 colon cancer, this can happen for several reasons:

• Cancer spreading to the lining around the lungs (pleura), causing fluid to leak
• Low protein levels (hypoalbuminemia) from poor nutrition and advanced cancer, causing fluid to shift out of blood vessels
• Heart strain related to the overall burden of illness
• Infection or sepsis complicating cancer

A significant pleural effusion will compress the lung from the outside, making it even harder to breathe — which is a major reason why your sister needs BiPAP.

Low Blood Pressure (Hypotension)

Low blood pressure in this context is a serious warning sign. In a patient with stage 4 cancer, hypotension can be caused by:

• Sepsis — a life-threatening response to infection
• Severe dehydration or fluid shifts
• Heart strain or reduced cardiac output
• Medication side effects
• The cancer itself affects normal body function

Low blood pressure means vital organs — the kidneys, brain, liver, and heart — are not receiving adequate blood flow and oxygen. This is what ICU teams call hemodynamic instability, and it often requires vasopressors (medications that raise blood pressure) and careful IV fluid management.

Heart Rate of 125 — Tachycardia

A resting heart rate of 125 beats per minute is a significant tachycardia. The heart is working extremely hard. In the context of everything else going on, this is the body’s response to low oxygen levels, low blood pressure, infection, pain, anxiety, fever, or fluid loss. A sustained heart rate, this high put additional strain on the heart and is a marker that the body is under extreme physiological stress.

THE CLINICAL PICTURE IN PLAIN LANGUAGE: Your sister is critically ill. She has stage 4 colon cancer, her lungs are compromised by fluids, her blood pressure is dangerously low, and her heart is racing to compensate. She needs non-invasive ventilation just to breathe. This is a situation that requires urgent, clear thinking — and as her medical POA, you have both the right and the responsibility to ask hard questions and get honest answers.

Treatment Options — What the ICU Team Can Do for Your Sister

1. Optimizing BiPAP and Respiratory Support

The ICU team will be adjusting the BiPAP settings — the pressure levels and oxygen concentration — to give your sister’s lungs the best possible support. If BiPAP is not enough to maintain safe oxygen levels, the team may discuss escalation to invasive mechanical ventilation through a breathing tube (intubation). This is a major decision that you as medical POA may be asked about.

Key questions to ask:

Is the BiPAP working?

Is her oxygen level improving?

What is her oxygen saturation target?

What happens if BiPAP fails?

2. Draining the Fluid — Thoracentesis or Pleural Drain

If the pleural effusion (fluid on the lungs) is large enough to be contributing to her breathing difficulty, the team may recommend draining it. This is done via a procedure called thoracentesis (a needle inserted between the ribs to drain the fluid) or a small pleural drain (a tube left in place for ongoing drainage). Draining fluid can provide significant relief and may improve her ability to breathe, sometimes dramatically.

Key question to ask:

Is the pleural effusion large enough to drain, and would draining it meaningfully improve her breathing?

3. Treating Low Blood Pressure — Vasopressors and Fluids

The ICU team will likely be giving IV fluids and possibly vasopressor medications — drugs like noradrenaline (norepinephrine) — to raise her blood pressure and protect her organs. This is standard critical care management for hemodynamic instability.

Key question to ask:

What is causing her low blood pressure?

Is it sepsis?

Is it responding to treatment?

What do her kidneys look like?

4. Investigating and Treating the Underlying Cause

It is important to understand whether your sister has an active infection on top of her cancer. If she is septic (infection causing her body to shut down), then IV antibiotics and source control will be critical. Blood cultures, chest X-ray, CT scan, and blood tests including lactate will all be part of the picture.

Key question to ask:

Does she have an active infection?

What are her blood cultures showing?

What is her lactate level?

5. Goals of Care Conversation — The Most Important Discussion

With stage 4 colon cancer and this level of acute illness, the most critical conversation you will have as medical POA is around goals of care. This is the conversation about what your sister would have wanted — and what the realistic outcomes of continued aggressive treatment look like versus a comfort-focused approach.

IMPORTANT: As Medical POA, You Have the Right to Ask: · What is the realistic prognosis with treatment vs. without? · What would full resuscitation (CPR, intubation) look like for someone in her condition? · Is there any reversible cause of this deterioration that could be treated? · What would my sister have wanted in this situation? · What does a palliative or comfort-care approach look like?

There is no single ‘right’ answer here. The right answer is the one that honors your sister’s values, wishes, and what she would have wanted for herself. Your role as medical POA is to advocate for her voice.

Why You Must Have Access to All Medical Records — Right Now

Alexis, one of the most important things you can do as your sister’s medical POA is to request and review all her medical records. I say this to every family I work with medical records is your roadmap to understanding what is really happening and what decisions are being made on behalf of your loved one.

The medical records will tell you:

• Her exact oxygen levels, blood pressure trends, heart rate patterns over time
• Her blood test results — including lactate (a marker of tissue oxygen delivery), kidney function, liver function, inflammatory markers
• What the imaging shows — chest X-ray, CT scan findings
• What medications she is on and at what doses
• What the ICU team has documented about her prognosis and goals of care discussions
• Any advance care plan or resuscitation order (DNR/DNAR) that may already be in place
• Ventilation charts
• Fluid balance charts

As her medical POA, you have the legal right to access her medical records. Do not be afraid to ask. Do not accept vague verbal summaries. Ask for the records, ask for a meeting with the ICU consultant (attending physician), and ask for everything to be explained to you clearly.

How a Consulting Call with Intensive Care Hotline Can Help You Right Now

You don’t have to navigate this alone. At Intensive Care Hotline, I and my highly specialized team of critical care nurses and intensivists are available to consult with ICU families in exactly this situation. We can review your sister’s medical records, help you understand what is happening clinically, and most importantly — we can speak directly with the ICU team on your behalf to ask the questions that matter and advocate for your sister’s best interests.

When we consult with the ICU team alongside you, we can:

• Ask detailed clinical questions about your sister’s condition, trajectory, and treatment options
• Clarify the goals of care and what each option really means
• Question decisions that don’t seem right or that haven’t been explained clearly
• Help you understand what the realistic outcomes look like with and without aggressive treatment
• Advocate for your sister’s wishes — whether that is maximum treatment or a dignified, comfortable death

Think of it this way: if you were about to board a plane and the captain was unavailable, would you want a flight attendant flying the plane? Of course not. You need someone with the right skills in the cockpit — and that is what Intensive Care Hotline provides for ICU families.

Here is how you can work with us:

Call us now on one of the numbers on the top of our website or email us to [email protected] or book a call with me here at  Visit: www.intensivecarehotline.com

 

Long-Term Option: Intensive Care at Home — Going Home on a Ventilator or BiPAP

Alexis, I want to make sure you also know about another option — one that is rarely discussed in hospitals but that can be life-changing for patients who need long-term respiratory support.

If your sister’s condition stabilizes and it becomes clear that she is going to need long-term ventilation support — whether that is non-invasive ventilation like BiPAP, invasive ventilation through a tracheostomy, or tracheostomy care without ventilation — then going home does not have to be an impossible dream.

My other organization, Intensive Care at Home, is Australia’s only third-party accredited specialist home intensive care nursing service. We bring ICU-level nursing care directly into patients’ homes, allowing them to live their lives outside of a hospital or institution — with their families, in their own environment, with dignity.

But even if you’re in the USA, Canada, UK, India or any other country please reach out to us, we can help you!

WHAT INTENSIVE CARE AT HOME PROVIDES: · 24/7 Critical Care Registered Nursing in the patient’s home · Invasive home ventilation — tracheostomy and mechanical ventilator management · Non-invasive home ventilation — BiPAP and CPAP management · Tracheostomy care for patients who cannot be weaned off the ventilator · Palliative home ventilation — for patients who choose comfort and quality of life at home · NDIS, TAC, and WorkSafe funding support and case management · Specialist Support Coordination (Level 2 and Level 3)

If your sister’s situation evolves to the point where she is stable enough to consider going home — even on a ventilator or BiPAP — we have helped hundreds of patients all around Australia in all states and territories and we can help your family too.

Learn more at www.intensivecareathome.com — and you can also read our evidence-based Mechanical Home Ventilation Guidelines at intensivecareathome.com/mechanical-home-ventilation-guidelines

The Bottom Line for Alexis

Alexis, your sister is in a critical situation. She is on BiPAP for respiratory failure, has a significant pleural effusion from her stage 4 colon cancer, dangerously low blood pressure, and a very fast heart rate. These are all markers of a critically ill patient.

As her medical POA, your job is not to know all the clinical answers yourself — your job is to ask the right questions, understand what is being said, and make decisions that reflect your sister’s own wishes and values. You are her voice. Take that role seriously.

Get access to her medical records. Ask for a family meeting with the ICU consultant. And if you feel overwhelmed, confused, or not being heard — call us. That is exactly what we are here for.

Call us now on one of the numbers on the top of our website or email us to [email protected] or book a call with me here at http://intensivecarehotline.com/scheduling-appointment/

Visit: www.intensivecarehotline.com

With care and respect,

Patrik Hutzel — Critical Care Registered Nurse | Founder, Intensive Care Hotline & Intensive Care at Home

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive 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 because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast  section where we have done client interviews because our advice is absolutely life changing.

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’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why I do one on one consulting and advocacy  over the phone, Zoom, 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 families directly, I also talk to doctors and nurses directly, asking 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 in case 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, and 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 eBooks and 21 videos that I have personally written and recorded. All of that will help you to improve your life instantly, 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.

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Your FREE Download: ICU Family FAQ: Sister on BiPAP with Stage 4 Colon Cancer

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.