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

So yesterday, I was on a phone call to a client and they have their 48-year-old father in intensive care and he’s had a cardiac arrest a few weeks ago, and he sustained potentially a hypoxic brain injury, but he’s had tracheostomy and he was slowly improving and then all of a sudden, things seem to have turned worse in terms of the gentleman’s CO2 (carbon dioxide) rising and the ICU is saying that they can’t do anything about it. Well, when we looked at ventilation settings, he was in a CPAP (continuous positive airway pressure) ventilation mode with a PEEP (positive end-expiratory pressure) of 8, pressure support of 12 to 16, and with FiO2 (fraction of inspired oxygen) of 50%, and his CO2 (carbon dioxide) was in the 70s millimeter per mercury, pretty high. And the ICU team was telling the family that nothing can be done.

And our suggestion was, of course, to change ventilation settings. He probably needs to go into a BIPAP (bilevel positive airway pressure) mode or into an SIMV (synchronized intermittent mandatory ventilation) mode, and change PEEP, change pressure support, potentially change the pressure control, if it’s in an SIMV mode, and get the CO2 down because he was more awake beforehand. And since the CO2 has been rising, he has basically been less conscious, which is no surprise with CO2 going into the 70s millimeter per mercury because CO2 makes people drowsy.

To make matters worse, all of a sudden, he dropped his blood pressure, and they would say that it’s not “in his best interest” to have fluid resuscitation or inotropes and save his life. It’s “in his best interest” to die. That in my mind, is highly unethical, highly immoral, and it goes against anything that I believe in, and it goes against anyone that is pro-life. He’s 48 and he’s got a young family to look after.

Now, cutting the long story short, we gave the family advice what should be happening, in terms of he needs a fluid challenge, either albumin or if his hemoglobin is low, he needs red blood cells, or he needs inotropes or vasopressors such as epinephrine or norepinephrine or adrenaline or noradrenaline to begin with, maybe vasopressin even. The ICU team was responding to the family and was giving albumin to begin with, and they were giving red blood cells and lo and behold, his condition improved. Also, they changed him into a BIPAP mode, and his CO2 came down.

So, here is another example that, you, as families in intensive care, you always need second opinions, and you always need to know what questions to ask. The family had no idea what questions to ask, what to look for, and that’s why it’s so important that you have your finger on the pulse from day dot that you get the best outcomes for your critically ill loved one in intensive care, especially if the intensive care team is negative, is nihilistic, is not pro-life, and makes statements such as it’s  “in the best interest” of a patient to die.

Especially now with services like Intensive Care at Home, there’s always the option to go home even on ventilation with tracheostomy and improve quality of life at home, and in some instances quality of end of life.

So, that is my quick tip for today.

If you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

And if you have a loved one in intensive care with tracheostomy and ventilation, and you want to look at discharging your loved one home, you should check out intensivcareathome.com. We are currently operating the service in all major capital cities in Australia. So, call us on one of the numbers on the top of our website there at intensivecareathome.com.

Also, have a look at our membership for families in intensive care 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, 24 hours a day.

Also, if you need a medical record review, contact us as well. We review medical records for patients in intensive care while they’re in intensive care, but also afterwards, especially if you’re suspecting medical negligence.

I would appreciate if you subscribe to my YouTube channel for regular updates for families in intensive care and Intensive Care at Home, like the video, share it with your friends and families, and click the notification bell.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and Intensive Care at Home, and I’ll talk to you in a few days.

Take care.