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Quick Tip for Families in Intensive Care: Why is My Dad in ICU Needing a Pacemaker and Can the Vasopressin Be Weaned Off Quickly?

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So today, I want to again answer a question from one of our members at our membership for families of critically ill patients that you can find at intensivecaresupport.org.

So, I’m going to read out the question from one of our members who’s had their dad in ICU for many weeks and she’s been getting great advice for us, making sure that her dad gets best care and treatment, making sure that she can make informed decisions, have peace of mind, control, power, and influence whilst her dad is in ICU.

So, here is the email from our member who says, “Hi, Patrik and team. I see the white dots on the ECG on the monitor in dad’s room, which I’m told indicates that his pacemaker is pacing. I get the basic concept that when your heart rate goes down to the set parameter of the pacemaker, the pacemaker will add extra beats for your pacing. Why is he pacing though while he is simultaneously being weaned off vasopressors? Usually, my dad’s heart rate is in the 80s at rest. The last few days, it’s been in the 60s.

Why doesn’t vasopressin get weaned the way the other pressors do? Dad is at 7 micrograms of norepinephrine, and they keep bringing it up and down based on dad’s blood pressure. How will he get weaned from the vasopressin? They just turn that vasopressor off completely instead of weaning.”

Here is our response, “Thank you so much for your email and updates regarding your dad’s condition. Please find our response here.”

“Why is he pacing though while he’s simultaneously being weaned off the vasopressors?”

Now, cardiac pacing is used when a person’s heart rhythm is irregular or too slow, which is also known as bradycardia. Bradycardia basically means if the heart rate is going less than 60 beats per minute, which is the case in your dad’s situation. It helps to ensure that his heart beats at a proper rate and maintains an adequate blood flow throughout his body. The use of vasopressors such as vasopressin, norepinephrine or epinephrine, or Levophed are medications used to support his blood pressure. Both pacing and the use of vasopressors can be used simultaneously as pacing addresses the electrical rhythm of his heart, while vasopressors address blood pressure regulation, which is crucial to optimize and maintain your dad’s heart function and overall health.

As his condition improves and stabilizes ensuring an acceptable heart rate and blood pressure with good tissue perfusion, the need for these medications may gradually be weaned off. This will be done under close medical supervision to monitor his response to treatment.

“Usually, my dad’s heart rate is in the 80s at rest. The last few days. It’s been in the 60s.”

The decrease in your dad’s heart rate from the 80s to the 60s at rest may be attributed to various factors such as the medication he is receiving, his overall health, or his response to treatment. They need to closely monitor his heart rate and adjust his treatment accordingly to maintain stable cardiac function.

Your next question, “Why doesn’t vasopressin get weaned the way the other pressors do? How will he get weaned from the vasopressin?”

In terms of vasopressin weaning, vasopressin is a medication that helps regulate blood pressure by constricting blood vessels. Vasopressin is sometimes reserved for situations where norepinephrine alone may not be enough to maintain his blood pressure. As a result, the weaning process for vasopressin may differ based on your dad’s response to treatment and the overall treatment plan.

So, on that note, what generally speaking happens in ICU when someone needs vasopressors, usually the first line vasopressor is norepinephrine or noradrenaline. Second line vasopressors are usually adrenaline or epinephrine. If you keep going up with norepinephrine, noradrenaline, epinephrine, and adrenaline and you’re coming to a really high rate and you still have a low blood pressure, then you need to add in vasopressin. That means you’re also weaning off vasopressin before you wean off the norepinephrine or noradrenaline/epinephrine or adrenaline. So, it makes sense that they’re trying to wean off the vasopressin first and foremost.

Now, back to your next question, “Dad is at 7 micrograms of norepinephrine, and they keep bringing it up and down based on dad’s blood pressure.”

Norepinephrine, on the other hand, is also a medication used to assist in maintaining blood pressure. The dosage of norepinephrine can be adjusted based on your dad’s blood pressure levels and how he responds to the medication. As I mentioned, as his condition improves and becomes more stable, the medical team may gradually reduce the dosage to avoid dependency and allow his body’s natural regulatory mechanisms to take over.

Next, “They just turn down, turn that vasopressor off completely instead of weaning?”

Again, weaning of the vasopressor is preferred over immediate discontinuation. Gradually reducing the dosage of the vasopressor allows your dad’s body’s natural regulatory system to adapt to changes in blood pressure, reducing the risk of abrupt drops in his blood pressure or other potential adverse effects.

The process of weaning off vasopressors like vasopressin and norepinephrine for your dad needs continuous and careful assessment from the medical team. It’s a delicate balance that needs to be carefully managed. The goal is to ensure that your dad’s blood pressure and cardiac function becomes stable enough to support his system. This approach aims to find the right balance of support and allows his body to manage his blood pressure without the need for these medications in the future. Additionally, the specific weaning plan will depend on his progress and how he responds to the changes.

It is important that the intensivist along with the cardiologist and other allied medical team needs to be actively involved with your dad’s treatment care plan. It’s also important that the doctors get to discuss your dad’s progress with the family and allow the family to raise any concerns.

You can also read through these articles from our website that can give helpful information about pacemaker and inotropes and vasopressors.” We’ll link below this video in the written version of this blog.

“I really hope this information helps. We continue to pray for your dad’s healing and recovery. Keep us posted.”

So, that’s the value that you get if you are one of our members for members for families of critically ill patients in intensive care and we offer that here at intensivecarehotline.com.

If you want to become a member, go and have a look at our membership at intensivecaresupport.org. There, you have access to me and my team, 24 hours a day, in a membership area and via email and we answer all questions, intensive care related.

I also offer one-on-one consulting and advocacy for families in intensive care over the phone, via Zoom, via Skype, via WhatsApp, whichever medium works best for you. I talk to you directly, of course. I also talk to doctors and nurses directly making sure all the questions that you haven’t even considered asking are asked and answers are given. So, the intensive care team cannot hide behind their medical jargon. I can break it all down for you and also read between the lines, which is really important when you have a loved one in intensive care.

We also offer medical record reviews in real time so that you can have a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, need closure, or if you are simply suspecting medical negligence.

Now, if you like my videos, subscribe to my YouTube channel, 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.

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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