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 My Dad Went into Septic Shock & is Now on Vasopressors, Is This Normal? Quick Tip for Families in ICU

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

Today, I want to read out a question from one of our members. It’s part of our membership for families of critically ill patients in intensive care. And we answer that question, of course, as part of our membership and you can actually see what value that you are getting once you are becoming part of our membership. So here is what our member says.

Hi Patrik and Team,

My dad went into septic shock on Sunday at 5 a.m. No one even called us. We found Dad alone in his room back on the ventilator with extremely low blood pressure when visiting hours started at 8:30 a.m.

So obviously, this is a member who has their dad in ICU and has been having their dad in ICU for quite some time now.

The LTAC (Long Term Acute Care) sent him to the hospital a month ago for a blood clot in his leg. He has been in 12 different rooms at the hospital as they have moved him everywhere. From the ICU to the general floor to telemetry to the step-down unit.

A few weeks ago, they started the Doxycycline as suppressive therapy for his supposed chronic osteomyelitis. I don’t think he has that. Seemingly unrelated, he then started getting low blood pressure a week or so later. They gave midodrine and slowly needed to increase the dose and frequency to a maximum of 30 mg, four times a day past this Saturday.

During that time, they were increasing the midodrine daily. They brought Dad to the ICU for one day where they said he was fine and improving and sent him back to the step-down unit where he spent one day before going into septic shock.

That Saturday the day before the septic shock, the ID (Infectious Disease) doctors continued to say that the symptoms Dad was having low blood pressure, fatigue, and increased oxygen need, were not related to an infection. It was his vascular system; it was his heart. The hospitalist group went into this long speech about how his “life force” was weak.

I laid into them and demanded better treatment. Explained that the cardiologist said that my dad’s heart is not the issue as it is only mildly reduced in function. Talking about his life force is appropriate medical discussion.

Finally, yesterday, infectious disease decided to talk to us after repeated requests. Yesterday was Thursday. My dad went into shock on Sunday. They said that they believed candida auris got into his blood by his midline. This is the midline that had been in his arm for over two months that we asked almost daily to have replaced considering Dad’s high infection risk.

On Sunday, Dad was on a maximum dose of all four available vasopressors. By Tuesday, he was able to get down to the maximum dose of two vasopressors: Levophed and vasopressin. Sunday and Monday, my dad was still communicating with us, not at all his normal self but still communicating. And on Tuesday, he stopped talking and stopped squeezing our hands when asking him.

On Tuesday, we also noticed his creatinine and other kidney numbers were increasing. Today is Friday. My dad has not communicated with us since Monday. His vasopressors have not been reduced since Tuesday and his kidney function has gotten worse.

Since Sunday, he was able to get off, of two vasopressors. He did a spontaneous breathing trial for 12 hours yesterday. Five of PEEP, 40% of FIO2, 8 pressure support, and his lactate acid is in the normal range with white cell count coming down by 10 from the mid-thirties to the mid-twenties.

There are a lot of positive things like his white cell count coming down. He’s breathing on his own for so long yesterday, et cetera. My main concerns are that he is not responding to us. He’s still on maximum dose of two vasopressors to maintain a MAP. Also known as mean arterial pressure between 60 to 80 and his kidneys.

They are going to start dialysis today. They said that it could be temporary since dad has never had any issues with his kidneys. And this is acute related to his septic shock. I’m so scared, angry and don’t trust them at all. Can you please tell me when my dad is going to wake up and come out of the shock? Will it be when his white cell count comes down more? We are praying so hard that God heals him again. That God allows him to have no pain right now and recover quickly. We know all things are possible through Christ.

Dad had septic shock once before in 2019, but he woke up once the sedatives were off. He’s not on sedatives now. He did not have a kidney issue in 2019. Ok.

Here’s our answer.

I understand your frustration and anxiety. I’m so sorry to hear that he’s in a critical condition. The unresponsiveness and kidney failure are due to septic shock. There was no adequate blood supply for the kidney and brain to function properly. His level of consciousness and decreased urine output are important indicators of poor perfusion and late septic shock. Recovery from septic shock is possible through aggressive antibiotic or antifungal treatment and restoration of enough blood to the body, especially in the major organs like the brain and kidneys.

However, we cannot guarantee a timeframe for his mental improvement, or will wake up when the white cell counts are back to normal. It could take weeks or months depending on his underlying health conditions and response to treatment.

Considering that he has medications to support his blood pressure on mechanical ventilation and for dialysis, he’s still in a critical condition.

The midline access should only last up to one month, ideally, but in your dad’s case, the catheter was in for over two months. Why was it left there for so long? He must have gotten the infection from this and spread easily in the bloodstream.

Given the mechanical ventilation settings, you provided 5 of PEEP, 40% of FIO2, and 8 pressure support for 12 hours. I believe your dad can get off the ventilator, but he should have rest periods from spontaneous breathing trials or be gentle with the weaning process. We don’t want hypoxia which is insufficient oxygen in the blood to happen as well, considering he’s still on two maximum vasopressors and for dialysis.

His blood pressure drops very easily during dialysis and can cause low blood supply again. I recommend other inotropes or vasopressors on standby or support with IV fluids just in case the blood pressure declines.

If there’s anything I can do to help or support you, please don’t hesitate to let me know we are here to help. We are with you in praying for your dad’s recovery.

Now, also your dad should have never gone to LTAC in the first place. We strictly advise against LTAC. And this is what happens. Patients go to LTAC from the ICU and they get sent back within no time because LTAC are simply not equipped to look after ventilated and tracheostomy patients. They do not have the skills. LTACs have been set up to save money, not provide the best clinical or medical care.

If you look at the online reviews of LTAC, it speaks volumes and you should also question why an ICU wants to send your loved one out so quickly from an LTAC. These should be big red flags for you.

Also with the midline, yes, it should be changed. Not after two months, it should probably be changed every seven days.

Also, another hint here is you mentioned that the ICU team told you, your dad’s heart is weak and yet he is on multiple vasopressors.  Now, if your dad’s heart was weak, he would most likely also be on a vasopressor or inotropes such as dobutamine or milrinone or potentially dopamine because those inotropes are increasing the contractility or the pump function of the heart given that he’s not on any of that chances of him having heart failure is, it’s probably negligible at this stage. And the cardiologist is probably right, they would have also done an ultrasound of the heart and giving you a measure called ejection fraction, also known as EF in medical terms, which once again would give you a measure of the pump functionality of the heart. The contractility of the heart. There’s no mention of that. We couldn’t find any reports about that in the medical record.

So if the vasopressors are not coming down or if they are introducing dopamine, dobutamine or milrinone, yes, then there could be a sign of heart failure, but that’s not the case at the moment.

So I hope that helps.

Now, if you want to become a member of our membership of families of critically ill patients at intensivecarehotline.com, go to our membership site 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 at intensivecarehotline.com. I talk to you directly, of course, to you and your families. I talk to doctors and nurses directly and I give you all the insights that you need. And I also ask all the questions to the doctors and nurses that you haven’t even considered asking but need to be asked.

Once again, 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, which is exactly what you are currently dealing with.

Now, next, we also offer medical record reviews in real-time so that you can have a second opinion in real-time. So contact us for that.

We also offer medical record reviews after intensive care. If you have unanswered questions, if you are suspecting medical negligence or if you are simply needing closure.

Now, if you like my video, 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.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.