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 question from one of our readers and the question last week was
You can check out the answer to last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer another question that we get quite frequently from our readers and in this week I want to answer
“HOW LONG DO YOU NEED TO BE ON A VENTILATOR AFTER A LUNG TRANSPLANT?”
Lung transplants for critically ill Patients are rising in numbers across the world and more and more critically ill Patients receive a life saving lung transplantation.
The major reasons to receive a life saving lung transplantation are
- chronic obstructive pulmonary disease(COPD), including emphysema
- idiopathic pulmonary fibrosis
- cystic fibrosis(cf)
- idiopathic (formerly known as “primary”) pulmonary hypertension
- alpha 1-antitrypsin deficiency
- replacing previously transplanted lungs that have since failed
- other causes, including bronchiectasis and sarcoidosis
most lung transplantations that I have seen over the many years while working in Intensive Care are straightforward and if all goes well they stay ventilated for up to two days, get extubated(removal of the breathing tube) and then get ready to go on to the ward and then go on to rehabilitation.
Lung transplant Patients are often on a clinical pathway and have certain boxes ticked
Critically ill Patients after lung transplantations often go on a clinical pathway, which means that certain conditions and certain preselected boxes have to be ticked in order to assess the progress of your critically ill loved one after having received a lung transplant.
This means that their vital signs such as Heart rate, heart rhythm, blood pressure, temperature and also vital signs for ventilation such as spontaneous ventilation- as opposed to mechanical ventilation– adequate oxygen levels, as well as good ABG’s(arterial blood gases) need to be prevalent in order for a lung transplant Patient to recover so that they can be discharged from Intensive Care.
Furthermore other tests such as their blood results need to be in order as well.
So, overall, if all goes well and straightforward and if they follow the clinical pathway, most critically ill Patients after lung transplantation don’t stay in Intensive Care for much longer than a few days.
Lung transplantations are high risk procedures
However lung transplants come with high risks attached and it starts with the pre-selection of suitable Patients, it continues with finding the right lung donor and right lung recipient(i.e. Patient).
After the pre- selection has taken place and the surgery has been performed and the critically ill Patient has gone into ICU, the wheels are in motion and the goal is to always get them off the mechanical ventilation as quickly as possible and as I have pointed out the goal is to follow the clinical pathway and get them off the ventilator within the first 24-48 hours after surgery.
However, as I have mentioned, lung transplantations come with high risks attached and sometimes things don’t go as planned, the donor lungs may not be a “perfect match”, there may be some bleeding and also the critically ill Patient will end up with a fair amount of new medications, specific to the management of lung transplantations.
You can find out all about the procedure of lung transplants and the medications required here in our clinical pictures section
Sometimes, when the lung donor- lung recipient match isn’t 100% and if bleeding occurs, ECMO for lung failure as a bridge to spontaneous breathing may be required.
This can go hand in hand with prolonged mechanical ventilation and it can go hand in hand with a Tracheostomy.
Sometimes, even after a new set of donor lungs have been transplanted in a recipient Patient, things may not go all that well.
Sometimes lung transplant Patients end up ventilator dependent with Tracheostomy
Even after careful pre- selection and after matching the donor and recipient, things don’t go as planned and Patients end up on the ventilator with a Tracheostomy.
This is a less than desired outcome, because the goals after a lung transplantation is clearly to improve the quality of life for the Patients and their families.
After more than 15 years of Intensive Care nursing in three different countries and after I have worked with literally THOUSANDS of critically ill Patients and their Families, I have witnessed some lung transplant Patients who end up with rejection of the new donor lungs.
This sometimes happens in the first few days or weeks after a lung transplant so that Patients never really leave hospital or Intensive Care in the first place or it can happen anywhere between 6 Months and 5 years after a lung transplant from my experience.
In any case, whether the rejection occurs relatively quickly or whether it occurs after Patients have gone home and had an improved quality of life, the outcome appears to be the same from my experience.
The issues that those critically ill Patients are struggling with tend to be difficulties breathing, increased oxygen requirements often resulting in mechanical ventilator dependency, Tracheostomy and an inability to wean the Patients off the ventilator.
The Patients that I have witnessed over the many years working in Intensive Care who are in this situation often stay in Intensive Care ventilator dependent with a Tracheostomy for long periods of time with no or a limited quality of life.
The sad reality in those situations is that this slow process often inevitably results in the death of the Patient.
Sometimes Patients end up in ICU for up to 6 months on a ventilator
I have witnessed some lung transplant Patients to approach their end of life and ultimately die after a long 3-4 month struggle on a ventilator in a clinical, sterile and limiting Intensive Care environment.
I am not advocating to stop treatment earlier and I am also not opposing to stop treatment when critically ill Patients and their Families face the dilemma of being ventilator dependent with Tracheostomy with no quality of life in Intensive Care!
It depends on what the Patients and their Families want.
What I do however, is to strongly advocate for Patients after lung transplants who end up long-term ventilator dependent with Tracheostomy then would be the time to look for a suitable alternative, rather than keeping these Patients and their Families in a limiting and inhibiting Intensive Care environment!
Suitable and proven alternatives to a burdensome long-term stay in Intensive Care
A suitable and proven alternative in this situation would be Intensive Home Care.
For example in countries like Germany and Australia, Intensive Home Care nursing services for long-term ventilated Adults& Children with Tracheostomy have long proven their concepts to be a genuine alternative to a long-term stay in Intensive Care and to improve Patients and their Families quality of life and/or quality of end of life in a holistic and more Patient and family friendly home care environment.
Those services, like INTENSIVE CARE AT HOME (WWW.INTENSIVECAREATHOME.COM.AU ) are providing tailor made services for long-term ventilated Adults& Children with Tracheostomy as a genuine alternative to a long-term stay in Intensive Care!
They are also creating an opportunity for Families to stop spending day and night in Intensive Care in order to be with their critically ill loved one.
INTENSIVE CARE AT HOME services are generally focused to provide a win-win situation and focus on the best interest for the Patients and their Families who are faced with the dilemma of long-term ventilation with Tracheostomy in Intensive Care.
INTENSIVE CARE AT HOME services also focus on the needs of Intensive Care Units and hospitals who generally have a shortage of precious and expensive Intensive Care beds and they tend to always have admissions waiting for those Intensive Care beds.
INTENSIVE HOME CARE is providing a win-win situation!
By freeing up those precious and expensive Intensive Care beds by taking long-term ventilated Patients with Tracheostomies home, a win- win situation is achieved.
Furthermore, a stay in Intensive Care is extremely expensive with costs around $ 5,000 per bed day. Therefore, Intensive Home Care is more cost effective, Patients and their Families are in a non-inhibiting and more holistic home care environment and Intensive Care units, hospitals and health care funding agencies pay less.
Again, it’s a perfect win-win situation.
For more information about long-term ventilation with Tracheostomy, you can also find more information here in these articles
- Tracheostomy and weaning off the ventilator in Intensive Care, how long can it take?
- How long should a Patient be on a ventilator before having a Tracheostomy?
- Why does my loved one need a Tracheostomy in Intensive Care?
- Why do doctors in Intensive Care insert a Tracheostomy after an induced coma?
- THE 7 ANSWERS TO THE 7 MOST FREQUENTLY ASKED QUESTIONS IF YOUR LOVED ONE REQUIRES ONGOING MECHANICAL VENTILATION WITH TRACHEOSTOMY IN INTENSIVE CARE
- FOLLOW THIS PROVEN SYSTEM TO AVOID THE 3 MOST DANGEROUS MISTAKES YOU ARE MAKING BUT YOU ARE UNAWARE OF, IF YOUR LOVED ONE REQUIRES LONG-TERM VENTILATION WITH TRACHEOSTOMY IN INTENSIVE CARE!
- PEACE OF MIND, CONTROL, POWER AND INFLUENCE EVEN IN THE MOST CHALLENGING OF CIRCUMSTANCES THAT YOU, YOUR FAMILY AND YOUR CRITICALLY ILL LOVED ONE COULD POSSIBLY FACE IN INTENSIVE CARE
- THE FAST LANE FOR PEACE OF MIND, CONTROL, POWER AND INFLUENCE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
I hope this article helps and sheds more light on ventilation requirements after lung transplants.
Sincerely, your friend
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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- 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
- How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
- 5 “killer” tips& strategies helping you to get on the right path to PEACE OF MIND, control, power and influence in your situation
- You’ll get real world examples that you can easily adapt to your and your critically ill loved one’s situation
- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
- You’ll get crucial ‘behind the scenes’ insight so that you know and understand what is really happening in Intensive Care
- 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” 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!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
- How the Intensive Care team is SKILFULLY PLAYING WITH YOUR EMOTIONS, if your loved one is critically ill in Intensive Care!