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If you want to know if TPN when a patient is on BIPAP in ICU is appropriate, stay tuned. I’ve got news for you.

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

Currently, we are working with a client who has their 90-year-old dad in ICU on BIPAP (Bi-level Positive Airway Pressure), and they’re at 70%, sometimes up to 100%, of FiO2 (Fraction of inspired oxygen) with an IPAP (Inspiratory Positive Airway Pressure) of 8 and an EPAP (Expiratory Positive Airway Pressure) of 18, and the tidal volumes are good, but the blood gases are reasonably poor. Currently, the intensive care team is struggling in keeping the patient from intubation but that is absolutely the goal.

Now, the issue is that the patient hasn’t had any nutrition for many days because of the BIPAP. They couldn’t really get any nasogastric tube feeds because of the risk of aspiration, with all the pressures going into the stomach.

So, the question is, what is the next step in terms of nutrition? Research and evidence-based is that you need to feed a patient in intensive care when they are critically ill in order to deal with the critical illness. They need nutrition. They need proteins, carbohydrates, sugars, and all the rest of it.

So, the question is, what to do next? There’s two options here. One option is TPN (Total Parenteral Nutrition), which means the patient would need a central line or a PICC line, or a jejunostomy tube. A jejunostomy tube, either a nasojejunostomy tube or a percutaneous endoscopic gastrostomy (PEG) jejunostomy tube.  We recommend either an NJ tube (nasojejunostomy tube) or TPN. Bottom line is that the patient needs nutrition.

It takes some advocacy to get this over the line because the intensive care team says, if you start using TPN, for example, it is a big infection risk. And whilst I agree there’s an infection risk, but to a degree, that’s like saying we stop eating and drinking because food might be contaminated. We have to eat and drink, irregardless of the low risk that is involved when you eat and drink, that food or drinks might be contaminated.

So, don’t let intensive care teams dissuade you from TPN in particular. But a nasojejunostomy tube is definitely also an option and should be discussed here as well, but the bottom line is that the patient needs feeding. The patient needs nutrition in order to deal with this critical illness.

So, that is my quick tip for today.

I have worked in critical care nursing for 25 years in three different countries, where I have worked as a nurse manager for over 5 years in ICU. I have 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. You can verify that in our testimonial section and on our podcast section, both at intensivecarehotline.com.

We have helped hundreds of clients and members over the years to improve their lives instantly when they have a loved one critically ill in intensive care by getting real results, by applying our proven strategies to get results for families in intensive care.

That’s why we created 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 link on our website, intensivecarehotline.com, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, via email.

And through the membership, you will also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded, helping you to make informed decisions, have peace of mind, control, power, and influence, so that your loved one gets the best care and treatment always.

I also do one-on-one consulting and advocacy over the phone, Zoom, Skype, or WhatsApp, whichever medium works best for you. I’ll talk to you and your family directly. I handhold you through this once-in-a-lifetime situation that you simply can’t afford to get wrong. I also talk to doctors and nurses directly. When I talk to them directly, I ask all the questions you haven’t even considered but that 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 you can get a second opinion in real-time. We also do medical record reviews after intensive care, in case you have unanswered questions, or if you suspect medical negligence.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers at the top of our website, or simply send 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, 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.

I also do a weekly YouTube live where I answer your questions live on the show . You will get a notification for the YouTube live if you’re a subscriber to my YouTube channel or to my email newsletter at intensivecarehotline.com.

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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