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Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we instantly improve the lives of Families of critically ill Patients in Intensive Care, so that you can 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 one of our most FAQ’s and the question was “How long does it take to wake up after being ventilated?” You can check out the answer to that question here.
In this week’s episode of “your questions answered” I answer another question from one of our readers and the question this week is
“My aunty is FAILING OVER AND OVER AGAIN to be weaned off the VENTILATOR and she has a Tracheostomy. She’s also on Kidney Dialysis, WHAT SHOULD WE DO?”
John writes
Hi Patrik
My aunt is on a ventilator. She was on the Tracheostomy collar for 5 days doing well and said “hi” to us and the next day she was confused, but she was also getting dialysis three days a week and all of this with no rest.
On the fifth day she got respiratory acidosis and she got put back on a ventilator. She was put back on the tracheostomy collar and again in about 3 days they started her on a 24 hour weaning regime again.
This time they did not start her on the 12 hour Tracheostomy collar and 12 hours on the ventilator like they did for several days to build her up to 24 hours on weaning and after 3 days she got respiratory acidosis again.
Both times this happened the night before she was doing fine. I noticed that they don’t respond to the alarm when she coughs. And it has an effect on her breathing. I think that that happens several times over the course of the night which may have contributed to the acidosis and she also had dialysis both days before the acidosis happened.
Her heart rate is more erratic now going from 94 to 115 BPM, before it was more regular between 70 To 85 beats per minute. Now they do not want to try and wean her again.
How can I make the Intensive Care team wean my aunty again? She has been on the ventilator for about 6 days now. Also her blood count was low about 7.4 which I believe affects the weaning. One of the respiratory therapist verified that it does affect the weaning.
This last dialysis they gave her a transfusion of 2 units of blood and she is more alert now. Please send me all the reports you mentioned in the two videos I seen on YouTube videos. Also send information you think may be helpful and why the heart rate changed.
Please send as soon as possible. Thank you for helping my aunt Caroline and me and her brother in this situation. It is greatly appreciated.
Thank you,
John
Dear John,
thank you for your question.
I’m sorry to hear what your aunty is going through in Intensive Care. I’m also sorry to hear what you and your Family are going through during this stressful time in your life.
From what you describe, there are a number of issues that I can see and it would also be helpful for me to know how long your aunty has been in Intensive Care in total since her admission and how long your aunty has had the Tracheostomy for. It would also be good to know how long your aunty had been in Intensive Care before she had the Tracheostomy.
If you could clarify those time frames, it would help me to give you the right type of advice.
In the meantime, I can advise you on the following, given the information you provided.
1) There is no reason why the Intensive Care team can’t wean your aunty off the ventilator and off the Tracheostomy. Unless there are any other reasons that you haven’t mentioned or that the Intensive Care hasn’t mentioned to you, there is no reason why the Intensive Care can’t start the weaning process all over again.
What you and your brother need to keep in mind though at all times are things like the Intensive Care team’s agenda, for example, does a prolonged stay in Intensive Care suit the Intensive Care team? For example, if the Intensive Care Unit currently experiences a low occupancy rate, would a prolonged stay of your aunty in Intensive Care contribute to their bottom line?
2) Low blood count of 7.4. I would think that you are referring to your auntie’s Haemoglobin. Haemoglobin is the marker in the blood for the red blood cells and the lower the number of red blood cells in the blood, it diminishes the ability for oxygen to be bound to the red blood cells and therefore carries around the oxygen in the blood. Some literature suggests that with a Haemoglobin level >8 the odds for success when weaning off the ventilator remains significantly higher, therefore giving your aunty some more blood transfusion would most likely help her situation.
3) Your auntie’s ongoing Haemodialysis. You are describing your auntie’s dependency for ongoing Dialysis therapy. I would think that your aunty is in acute or chronic renal or kidney failure. There are a number of issues that come with acute or chronic renal or kidney failure in Intensive Care, especially when it relates to weaning off the ventilator.
If your aunty is in renal or in kidney failure and if she doesn’t get regular haemodialysis, fluids will build up in the lungs that can make weaning off the ventilator more difficult, therefore regular haemodialysis is most likely essential for your aunty to be successfully weaned off the ventilator.
Having said that, with ongoing haemodialysis, your aunty will most likely also experience a drop in Haemoglobin(red blood cells) which in turn is requiring regular blood transfusions to keep her haemoglobin levels up.
4) Your auntie’s increased and erratic heart rate. It’s rather normal to have an increased and even erratic heart rate when being ventilated and in Intensive Care. Imagine the stress your aunty is going through mentally and physically whilst being in Intensive Care as well as the stress her body is going through whilst undergoing the therapy in a stressful, busy, noisy and sterile environment that is Intensive Care. The best way to treat your auntie’s increased heart rate is to wean her off the ventilator and get her out of Intensive Care.
Also make sure that she isn’t in pain or discomfort because if she is, it would increase her heart rate as well.
Here are also some links to articles as they relate to ventilation and weaning and Dialysis in Intensive Care
- Tracheostomy and weaning off the ventilator in Intensive Care, how long can it take? https://intensivecarehotline.com/tracheostomy-weaning-ventilator-intensive-care-long-can-take/
- Why does my loved one need a Tracheostomy in Intensive Care? https://intensivecarehotline.com/what-is-a-tracheostomy-used-for-in-intensive-care/
- Why your critically ill loved one might need Dialysis(Kidney machine) or Hemofiltration for Kidney Failure(Renal Failure) and is having a Dialysis machine attached to them https://intensivecarehotline.com/critically-ill-loved-one-might-need-dialysiskidney-machine-haemofiltration-kidney-failurerenal-failure-dialysis-machine-attached/
- The five things you need to know if your loved one is confused, agitated and non- cooperative in intensive Care after coming out of an induced coma https://intensivecarehotline.com/5-things-need-know-loved-one-confused-agitated-delirious-intensive-care/
Other recommended resources:
Also check out INTENSIVECAREATHOME.COM.AU if your aunty gets to stay in Intensive Care for longer than expected, even if she stays on the ventilator! INTENSIVE CARE AT HOME is a home care service and a genuine alternative to a long term stay in Intensive Care for long-term ventilated Patients with Tracheostomy.
Check it out here www.intensivecareathome.com.au
I hope that helps John and please send me another email with more questions if you have any.
How can you have PEACE OF MIND, control, power and influence whilst your loved one is critically ill in Intensive Care?
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In your FREE reports you’ll also discover
- How to ask the doctors and the nurses the right questions
- Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
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- 5 “killer” tips& strategies helping you to get on the right path to PEACE OF MIND, control, power and influence in your situation
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- How you need to manage doctors and nurses in Intensive Care(it’s not what you think)
Thank you for tuning into this week’s episode of “your questions answered” and I’ll see you again in another update next week!
Make sure you also check out our ”blog” section for more tips and strategies or send me an email to [email protected] with your questions!
Also check out our Products section where you get more Ebooks, Videos and Audio recordings and where you can also get 1:1 consulting!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
Sincerely, your Friend
Patrik Hutzel
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