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 our readers and the question last week was PART 3 of
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 from one of our readers and the question this week is PART 4 of
“MY AUNTY IS IN INTENSIVE CARE ON ECMO FOR ARDS, WE’RE VERY WORRIED SHE MAY DIE! HELP!” (PART4)
Lee from the UK writes
I have been been to the hospital again today.
My aunties condition deteriorated more over night she is now on 65% oxygen on the ventilator.
Her sedation has gone higher as well and they have started another antibiotic.
She now has a new infection which has shown on her lung x rays.
The x-ray is also showing no improvement they said turning her on to her tummy is the next step.
The ecmo team has been down to take a look and at the moment they said she is not at that stage yet where she needs ECMO again and there is a chance that she may be refused because they think if the dialysis machine doesn’t work this time her lungs may have chronic damage!
They say that chronic lung damage may not be reversible and that’s why they will refuse her. Do you know whether there’s anything else what they could do for her or is that the maximum they or any one could offer to my aunty?
it sounds like your aunty has gone backwards and again this can happen.
Turning your aunty/ sister might help and in the “old days” before ECMO, Patients on ARDS were “proned”, meaning they were turned face flat on to their tummy with head down in order to drain the lungs and give them a rest.
This can be very effective and I have seen this in the days before ECMO to be effective in some Patients. It requires lots of sedation though as it can be very uncomfortable for Patients. And again, it can be very effective though.
Often oxygen requirements would come down when Patients with ARDS get proned. This can be a lengthy process though and it often took a few days of consistent proning with 12-15 hours proning and then back on a Patients back and so forth.
Another option might be “high frequency oscillation ventilation”, which is a form of ventilation that protects the lungs by delivering small volumes with a high respiratory rate(=breaths per minute) in order to deliver oxygen and air.
It depends on whether they have such a ventilator in the ICU or not, however I would argue given that your aunty tolerated ECMO in the first place that she should go back on ECMO, however her oxygen requirements of 65% is probably too early to indicate going back on ECMO as yet.
In order to provide maximum therapy for your aunt means that after they tried proning and if that doesn’t work that they may consider the high frequency oscillation ventilator or the ECMO again.
If you could please clarify why she is having the dialysis that would be good. Sometimes Patients have Dialysis even though their kidneys are working and they have it because they need to get rid of extra fluids to keep the lungs “dry”, which is very important in ARDS.
Also, I mentioned yesterday, do not buy into the mindset of the Intensive Care team when they say that your aunty can’t go back on the ECMO when dialysis may not work.
It’s most likely that if your aunty is going back on ECMO that she will improve very quickly. Even though ECMO may not be a cure, it gives your aunty another chance for her lungs to get another rest and hopefully improve.
Again, I’ve seen Patients being on ECMO for up to 3 weeks, so once again, not giving her the option to back on ECMO might be a decision you may have to push for if you think it’s the right thing to do.
Another option is that if the ARDS can’t be cured that your aunty may be considered for the lung transplant list.
Sometimes, Patients on ECMO for ARDS/ lung failure can be put on the lung transplant list and ECMO can be a vehicle to bridge them to a new set of lungs if it becomes available.
Also keep in mind that now your aunty is “only” dealing with single organ failure which is the lungs.
Would she be on dialysis for kidney failure she would be dealing with multiple organ failure.
Keeping the lungs dry during ARDS is important to not have any excess fluids on the lungs and aid the healing process.
Because your aunty is only dealing with single organ failure(the lungs) it provides a stronger case for going back on ECMO if need be!
Those are all questions you should be putting forward to the Intensive Care team.
Also, if the Intensive Care team remains negative and they don’t want your aunty to go back on ECMO you need to dig a lot deeper and you need to consider asking all of the following questions:
- What are the things that are happening “BEHIND THE SCENES” that you are unaware of?
- For example, why are they positioning your aunt’s prognosis and diagnosis the way they position it?
- Are there resource constraints? Does the Intensive Care team want to treat other Patients that they see as more financially viable? Do they want to treat other Patients where they can do medical research on?
- Are they treating other Patients because Families demand it? if so, you should demand it too.
That’s why it’s important that you talk to other Families who have a loved one in the ICU.
- Also, are they currently experiencing a high demand on their precious, scarce and expensive ICU beds and therefore “pulling out” and withdraw or stop treatment might free up a bed that they can use for the next admissions.
- How MEDICAL RESEARCH DOMINATES your critically ill loved one’s diagnosis and prognosis, as well as the CARE and TREATMENT your loved one IS RECEIVING or NOT RECEIVING!
- THE 10 THINGS YOU DIDN’T KNOW ARE HAPPENING BEHIND THE SCENES IN INTENSIVE CARE THAT HOLD YOU BACK FROM HAVING PEACE OF MIND, CONTROL, POWER AND INFLUENCE, WHILST YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- INTENSIVE CARE’S HIDDEN SECRETS AND MYTHS BEHIND THE SCENES, THAT THE INTENSIVE CARE TEAM KEEPS AWAY FROM YOU AT ANY COST AND OTHER FAMILIES OF CRITICALLY ILL PATIENTS HAVE NO CLUE ABOUT THOSE HIDDEN SECRETS!
- THE 5 THINGS YOU NEED TO KNOW IF THE MEDICAL TEAM IN INTENSIVE CARE WANTS TO “LIMIT TREATMENT”, WANTS TO “WITHDRAW TREATMENT” OR “WITHDRAW LIFE SUPPORT” OR WANTS TO ISSUE A “DNR” (DO NOT RESUSCITATE) OR AN “NFR” (NOT FOR RESUSCITATION) ORDER FOR YOUR CRITICALLY ILL LOVED ONE!
And everything might be fine, your aunty/ sister might improve without the ECMO and if she’s not then you have to be prepared to stand up for your loved one!
Intensive Care teams can be very shrewd and adept at “selling” you and your family on a “withdrawal of treatment” as being “in the best interest” for your loved one if you are unprepared and if you don’t know what’s happening “BEHIND THE SCENES” in Intensive Care!
So let me know how things go and I will keep answering your questions!
Take care and stay strong!
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In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care! In your FREE report 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
- 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!
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!