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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 shared another question in this series of questions from my client Veronica and the question last week was PART 10 of
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 one of my clients Veronica, which are excerpts from phone and email counselling and consulting sessions with me and the question this week is
My Dad (71) is in ICU with stage 4 lung cancer & stroke, he’s on the ventilator now and in an induced coma, what are his chances of survival? (PART 11)
You can also find previous counselling and consulting sessions with Veronica here
PART 1, PART 2, PART 3, PART 4, PART 5, PART 6, PART 7 , PART 8 and PART 9
In last week’s 1:1 counselling and consulting session we talk about why her Dad “only” has single organ failure and not multi organ failure and why the distinction is important!
I also explained to Veronica how the ICU’s bed occupancy is impacting on her Dad’s treatment and care.
Furthermore, I share with Veronica what advantages a service like INTENSIVE CARE AT HOME would have for her Dad!
Thank you Patrik,
I have watched the video “WHAT ARE THE RISKS AND BENEFITS OF A TRACHEOSTOMY?”, I want to share this info with my family first before the meeting today. If we decided to do this for dad.
Would it be best for my dad to have this done before they wake him from sedation in his situation as he will need the suctioning? Or is it best for him to make that decision when we wake him? I’m concerned he will get stressed again when he can not breath and cough up mucous. But if he can not talk at all he might get very depressed and if he can not eat he will be very upset also. This is not an easy decision and I want time to discuss this with the Doctors and my family. How much time do we have if they give us the chance to do this tracheostomy?
If the doctors agree to this or are open to this how long can we think about this, to make the right choice ?
Thanks
Veronica
Good morning Veronica,
Most ventilated Patients in Intensive Care needing a tracheostomy will have it done while they are in an induced coma. After the tracheostomy has been done, sedation can be taken off straight away in most cases.
In some cases, a trial extubation(=removal of the breathing tube) is being done first and if the Patient fails to breathe by themselves the breathing tube is being re-inserted(=intubation). After the breathing tube has been re-inserted a tracheostomy is being done as a next step.
Related articles/videos:
You are absolutely correct that this is not an easy decision. It’s most likely that your Dad will get stressed again if he cannot breathe by himself and coughs up mucous.
On the other hand, yes a tracheostomy won’t enable your Dad to talk or eat. It’s a catch 22.
Given that we are potentially dealing with an end of life situation, it’s important to weigh up what your Dad would want if he can’t make the decision himself. Currently your Dad isn’t in a position to make the decision himself!
I believe that quality of life and his comfort need to be considered first and foremost. Therefore comfort care and/or palliative care needs to be considered also.
I’m very happy to answer more questions regarding tracheostomy if you want to discuss.
I can be available pretty much anytime today, the only time I’m unavailable is between 12pm-1pm.
Kind Regards
Patrik
Recommended:
Hi Patrik,
After we finished the call today at the hospital
Dr xxxxxxx who spoke with us the critical care intensivist arranged for us to meet with Dr xxxxxx the respiratory specialist he met us at 7pm at the hospital and we asked him all the same questions and more and he also showed us dad’s latest CT chest scan. The scan clearly shows the lung is not good and dad has about 1/2 a lung between the two lungs that are healthy tissue the rest is cancer, damage, infiltration and inflammation.
It was important for us all to see this and now we understand more about the condition of the lungs.
I again asked about the tracheostomy and also the treatment options for fibrosis and he said earlier these fibrosis treatments may have helped but not at this late stage. He suggested we leave dad sedated and in the induced coma on the ventilator and keep him sedated and then let him go by removing the breathing tube as this would not cause him so much stress but my mum and brother and I now agree to wake him up and see what dad will do once the tube is out and they will put him on the BIPAP mask and make sure he is comfortable this way until nature takes its course.
The respiratory doctor and the Oncologist Dr xxxxxx (who I called after we spoke with the respiratory Physician) said he can not treat dad’s cancer anymore and the tracheostomy will just prolong his suffering and advised against it. So all doctors are against it based on the CT chest scan results.
We did not give the Intensive Care doctors any instructions until we have a sleep on the decision. And advise them tomorrow afternoon. We are of the decision now to try to start to take dad of the sedation tomorrow night and be with dad when he wakes up Friday am.
I’m working 1/2 day tomorrow now so I can go to hospital early to let the doctors know what we decided as a family. I am taking the rest of the week off to spend in hospital to help
Dad and be by his side.
Thank you for your advice
Veronica
Hi Veronica,
Thank you for the update.
I’m glad that you were able to get more information, especially that you were able to get to look at the CT scan.
In light of the fact that basically only 50% of the lungs are working, a tracheostomy would indeed only prolong the inevitable.
I think waking up your dad and see what happens is wise and being with him will be a good thing, maybe he can talk and advise you what he wants.
I think it’s good to sleep on the decision and then move forward when you and the rest of your family feel ready.
With all the information that I now have, I would imagine that your Dad’s comfort should be priority once the breathing tube has been removed and comfort can be achieved with drugs like Fentanyl/ Morphine and Midazolam. Midazolam is known as a sedative and it will help your Dad go to sleep quickly. Morphine or Fentanyl are strong pain killers also known as opioids.
The focus now clearly need to shift to comfort care and palliative care to make sure your Dad is not unduly suffering.
With all the information you have shared for now and as far as I can see, he is in a “real” and not in a “perceived” end of life situation!
Related article/video:
It’s good that you and your family have clarity now and even though it’s very sad that your Dad is realistically dying in the next few days, at least you now know what you are dealing with and you can start managing it appropriately.
The next step is to look at timelines, which you have already done to a degree.
You also may want to prepare the rest of your family what is going to happen over the next few days and I can help you with that and talk them through it what to expect.
It sounds to me like you want to be there when your Dad is going through the last stage of his life. You may want to find out if your mother and your brother want to be there also. Whatever they decide will be fine, don’t judge them for it. Not everybody has the strength and the courage to sit besides one of their family members dying. Don’t judge them either way.
Next, make sure that all of your Dad’s cultural, spiritual and religious needs are met before your Dad’s passing, this may be very important for your Dad and also for other family members.
Again, you could still also consider INTENSIVE CARE AT HOME and have your Dad extubated and go on BIPAP at home and have him pass away at home.
Related article/video:
Please also keep in mind that when Midazolam and Morphine or Fentanyl are being started after or before removal of the breathing tube (=extubation) things can happen very quickly.
Your Dad may pass away quickly even though he’s going on the BIPAP. Morphine and Midazolam have respiratory depression as one of their main side effects, therefore getting your Dad off the ventilator and the breathing tube with less than 50% of lung capacity may get your Dad to pass away quickly, maybe with in a few hours or so after extubation.
It’s difficult to put time lines on this but I’d say from experience, it will probably be hours and not days.
The other thing from an ethical, moral and potentially also religious point of view is whether you consider giving sedation such as Midazolam and Morphine as euthanasia, given it’ll aid your Dad passing away peacefully.
It’s standard practice in Intensive Care and many people- including myself- struggle with the concept of helping people dying.
Have a think.
I’m very happy to talk to you today, pretty much anytime if you want to discuss or have anymore questions.
Kind Regards
Patrik
How can you become the best advocate for your critically ill loved one, make informed decisions, get peace of mind, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?
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- How to ask the doctors and the nurses the right questions
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- 5 mind blowing tips& strategies helping you to get on the right path to making informed decisions, get 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 YOUR QUESTIONS ANSWERED episode 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!
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!