Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So currently, we are working with a client who has their 80-year-old father in intensive care after heart failure. He is now in sepsis, in kidney failure, and he’s on dialysis. And the intensive care team is saying that he’s in multi-organ failure and that he’s probably going to die. He’s also on a ventilator with a breathing tube and they’re slowly trying to wake him up.
What they’re not saying is that he’s actually on minimal support on the ventilator, which negates what they’re saying in terms of that he is in multi-organ failure. Yes, the kidneys are failing. Yes, the heart had a heart attack. But he’s actually not doing too badly, given that he’s still on a ventilator. And you got to question everything when you have a loved one in intensive care.
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.
So, coming back to our client’s situation, the intensive care team is very negative, saying that his heart is so weak that he probably can’t be weaned off the ventilator. Now, the question that we ask is, what’s the cardiologist saying after the heart attack? And the cardiologist is saying that they are considering 1 dose of levosimendan to increase the contractility of the heart, which makes perfect sense to me. But there seems to be a delay, even though the client’s ejection fraction, which is the contractility of the heart, is only 33%. I would argue that he is in urgent need of a dose of levosimendan.
Other medications that can be used are dobutamine or milrinone to increase and improve the contractility of the heart which would help with ventilator weaning.
And if we haven’t asked those questions, the family would have never found out about those options and the intensive care team would’ve just simply withhold such crucial information. This is why you need to do your own research. You need to get professional help. You need to get a second opinion. Because the intensive care team will tell you what they want to tell you with leaving half of the story away. And again, you need to actually also know what you should be asking.
Intensive care is a highly specialized area, and the devil is in the details.
So, once their family member had some levosimendan, or dobutamine, or milrinone, the contractility of the heart will actually improve, which will help with ventilator weaning. And we know he’s been breathing on CPAP or spontaneous pressure support in the last few days already. So, you have to question when the intensive care team says, “Well, he’s in multi-organ failure”. But you got to actually look at the details. Yes, the heart is not in good shape at the moment. Yes, the lungs are not in good shape at the moment. The kidneys are taken care of by the dialysis machine. But once levosimendan, dobutamine, or milrinone have been started, the heart will probably improve. And then weaning off the ventilator becomes much more likely.
That is my quick tip for today.
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This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.