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If you want to know what a real end-of-life situation looks like when you have a loved one, critically ill in intensive care, 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.

With my videos over the many years here at intensivecarehotline.com, I’ve been talking about, “What is a real versus a perceived end-of-life situation in intensive care”. Perceived end-of-life situation is that there’s a perception that there could be an end-of-life situation, but there’s often things that can be done, and often a perceived end-of-life situation can be turned around. However, there are also real end-of-life situations where no treatment, no medication, no surgery, no equipment, no resources can really save someone’s life. Today, I want to actually focus on that.

We’ve been working with a client recently who has had their loved one pass away in intensive care unfortunately, and that was after multiple cardiac arrests within a reasonably short period of time, within a few days.

Initially, the patient came in with the cardiac arrest and then had ongoing cardiac arrests after about two weeks in intensive care and things weren’t looking good. The patient went into kidney failure and ended up on dialysis for kidney failure, ended up on multiple, multiple inotropes and vasopressors such as norepinephrine, Levophed, vasopressin, phenylephrine, and so forth at maximum doses.

Maximum doses means that when blood pressure is low from a cardiac arrest, for example, and not compatible with life, that’s when you need to give inotropes or vasopressors that increase the blood pressure with infusions but then there’s only so much you can go up with a weak heart. The heart was very weak. That means, no matter how many inotropes you are giving, it can no longer compensate for the weak heart.

Then another sign was that the ICU had to take the patient off dialysis because, again, the blood pressure was going down too low by being on dialysis. Basically, organs were shutting down, and PH (potential of hydrogen) in the blood was very acidotic. So, lactate increase, you got to look for lactate levels in a situation like that. When lactate keeps going up, it basically means that the body persistently produces too much lactic acid and that is a sign that liver and kidneys are consistently not functioning well and are basically shutting down. This occurs in the context of a critical illness and as blood lactate levels continue to rise and PH levels fall, cardiac output is increasingly suppressed, which leads to organ failure and death. Those are clear signs that, unfortunately, a patient in intensive care is dying.

Other signs in a situation like that are clearly that ventilation requirements are very high, i.e., this particular patient was on 100% of FiO2, that means 100% of oxygen from the ventilator in a controlled ventilation mode, meaning the ventilator was doing all the work. The patient could no longer do any attempts to breathe at all, with a PEEP (Positive End-Expiratory Pressure) of 12 and with a rate of 35. Bear in mind, when I say FiO2 (Fraction of inspired Oxygen) 100%, room air, the air that you and I are breathing is 21%. So, that means the ventilation requirements were maxed out.

So, this is what a real end-of-life situation looks like. Lactic acid, by the way, was 7. Normal level is below 1.5. The white cell count was high, which suggested an ongoing infection. Low sodium levels, creatinine was high, BUN (Blood Urea Nitrogen) was high, and GFR (Glomerular Filtration Rate) was high. Those are signs that unfortunately, a patient is dying and that nothing can save someone’s life.

Now, please keep in mind that approximately 90% of patients in intensive care survive, that’s the research. So please keep that in mind as well.

If you’re watching this, and you’re wondering, is your critically ill loved one dying? What are the odds? The odds are usually 1 out of 10 isn’t surviving in intensive care. So, the odds are actually in your loved one’s favor.

Now, in this particular case, there were other issues adding on to it. The patient had chronic AF which is atrial fibrillation, was on amiodarone, and had heart attacks even prior to going into ICU. So, the prognosis wasn’t great right from the start, but I just thought you needed to understand what a real end-of-life situation looks like and in a situation like that, unfortunately, there’s nothing that can be done.

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. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com.

I can confidently say we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at the intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section at intensivecarehotline.com where we’ve done client interviews that verify the work we’ve done for them.

We have helped hundreds of members and clients over the years helping them to improve their lives instantly, saving their lives. That is why we created 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 e-books and 21 videos that I have personally written and recorded. All of that will help you to make informed decisions, have peace of mind, control, power, influence, making sure your loved one gets best care and treatment always.

I also do one-on-one consulting and advocacy over the phone, Zoom, Skype, 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 can’t afford to get wrong. I also talk to doctors and nurses directly. I ask 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 you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

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.

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, comment below what you want to see next, what questions and insights you have from this video, share the video with your friends and families.

I also do a weekly YouTube live where I answer your questions live on a show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel or if you are a subscriber 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.