Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question where I featured another CASE STUDY and the case study last week was
You can check out last week’s episode by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next question from our client Robert, which are excerpts from email counselling and consulting sessions with me and the question this week is
My 68 year old mother is in ICU with gastric perforation and she’s not “waking up” after the surgery! Will she need a tracheostomy? (PART 11)
You can find previous questions from this series of questions answered here
Robert continues with his mother’s situation below
when my mom was in Brazil, she was given the antibiotic Colistin. Best we could tell, it was effective for whichever bacteria she had at the time.
Here at the Hospital in Seattle, US, they’ve given her several other antibiotics as part of treatment, but they’ve held back on Colistin because it’s known to negatively impact kidneys and is generally considered a “high-powered” antibiotic that they don’t use loosely.
So, what we were wondering is this: Given that she’s starting on dialysis and the fact that mom’s kidneys were generally healthy (she did not have chronic kidney disease or anything) and the fact that we know that she responded well to Colistin in Brazil, would you think them going ahead and giving her Colistin a good idea? (Obviously, we can’t actually make that decision — but wondering if we should ask the question and plant the idea).
Colistin is usually given for Pseudomonas infection.
Do you know
a) where they located the infection at the time and if it definitely was a Pseudomonas infection?
b) if your mother had her kidneys deteriorate in Brazil but not needing Dialysis?
c) was Colistin definitely effective during her hospital stay in Brazil?
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a. Here are the responses to your questions (this is the best we know right now, as our time in Brazil was a bit crazy):
b. I don’t think they had narrowed it down, and we are not sure it was a pseudomonas infection.
c. To the best of our knowledge, there was no kidney function deterioration in Brazil. That was not an issue. Doctor said that the reason may be that she had healthy kidneys then, and could take the hit. Her worry is that it’s not the case now and Colistin is almost certainly going to hit the kidneys.
We can’t be absolutely sure. What we do know is that she was treated with Colistin and the infection seemed like it was brought under control.
Our general thinking is: They’re giving her roughly 10-20% odds of making it through (we realize there are never perfect numbers). But if Colistin is one more “tool” to help her fight infection, and she’s been on it before, we’re wondering if it’s worth treating her with it.
The downside I can think of is that right now, her kidneys may have a chance of recovering (not sure what the chances are of that yet), and the Colistin might reduce those chances?
thank you for clarifying.
Here is what I’m thinking and I’m thinking more in terms of bigger picture here
- You are correct to point out that “their numbers” (10-20% survival chance) are never perfect. It may be good as a guide post, but I also know from experience that it’s an educated guess at best
- With bigger picture I really mean looking at issues such as your mother’s white cell count (and other blood results), her Temperature or lack of such, her heart rate and if she can come off the inotropes/vasopressors – those are all indicators in how well she’s fighting the infection
- I would also be curious to know what they have grown from various sources by now I.e. is there Pseudomonas in the lungs now? Where is the E.coli, in the gut or has it spread elsewhere?
- As a general rule and from my experience, when Patients are critical and are fighting an infection, the right antibiotics can make a difference, even with side effects such as (temporary) kidney failure
- I do think however that from your last email, there are signs of improvement compared to 48 hours ago, therefore I am thinking if it’s the infection only that is her major issue at present?
- What’s she doing now in terms of ventilation, I.e. how much oxygen is she on, What’s her PEEP (=Positive end expiratory pressure) like and what are her Arterial blood gases like?
- I will stand by that the kidneys are the most “forgiving” organ and have a chance of recovering after critical illness- Having said that with your mother’s underlying Diabetes, there is a higher chance of developing kidney impairment
- One way or another, as long as she has an infection and there are no treatment limitations, it is their duty to find the right antibiotic and weigh up pros and cons with you and your family if it’s the right thing to do or not
I hope that helps Robert. Let me know if you need more clarification around this or any other issues.
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
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