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 last week’s question here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I’m coming back to one of our readers Ellie, who’s Mum has been in Intensive Care for about three months now. As Ellie’s Mum continues to get better she still has some challenges on her journey to recovery.
Therefore Ellie continues to ask questions and today Ellie has another question regarding her mother’s swallowing after Tracheostomy removal.
“My Mum has been in ICU for three weeks now and she is on ECMO for ARDS! Will she survive?”(PART 5)
You can check out previous questions from Ellie regarding her Mum here(click on the links)
Today, Ellie writes
writing for your advice again!
My mum finally had the tracheostomy out on Tuesday (which was actually my birthday!)
She has been eating yoghurt 3 times a day (5 teaspoons) and then had a milkshake (Fortisip) added. Since the Milkshake and the stopping of the antibiotics (which they have just re- started) she has a new infection on the lungs. The doctor showed me the X-ray taken today compared with the one on the 28th July and todays X-ray is all misty.
My mum is desperate to eat and drink and the doctor told me that it could now be weeks if not months that she won’t be able to eat and drink because they think her swallow is too weak and that the food is going into the lungs (aspiration)
I’ve told my mum they will re look at it all on Monday. For now she has to wear the simple oxygen mask with steam 24/7 . I asked for the nose specs at night which she had last night for 4 hours before she de- saturated and they put the mask back on.
It’s really upsetting. They have also said she may well go back into the ICU so they can keep a closer eye on her. I know this is for the best as the nurse is hardly around in her side room and she is still weak in her arms and hands (and the rest of her body).
I really don’t want her going back into scary ICU. The doc has also made me promise I won’t feed her yoghurt and has said she may end up back on the Ventilator or dead if I do.
Physio rehab has halted with just a little chest physio.
Could it really be aspiration and not the stopping of the antibiotics? It seems to me that if they have stopped the antibiotics then there is no good bacteria anywhere to return, only bad.
I know this is highly simplistic and grasping at straws. I want my mum to eat something. She says she’s so weak and feels stronger and much better when she is and seemed that way to me. Plus how is her swallow going to get any stronger if she’s not swallowing!?
I am also so fearful of her returning to ICU on the ventilator so I’m praying the infection will clear up over the weekend.
Any advice would be much appreciated.
that’s a nice birthday present for you to finally have your mother’s Tracheostomy removed!
Congratulations for taking this big step! You and your mother are fighters and you have shown true strength throughout this challenging and difficult time! So give yourself a pat on your back!
Overall, you and your mother have come a long way and it took a long time to get there and now the last thing you want is for your mother to have the Tracheostomy to go back in, go back on the ventilator and go back to ICU.
It would be a setback indeed to go back to Intensive Care!
From what you are describing, I am however a little worried that they might have taken the Tracheostomy out a little too early, even though I know you had to wait what felt like a lifetime for your mother to finally get there.
I know that’s probably not what you want to hear and I can only make my assumptions from here without actually having seen your mother.
That doesn’t mean all is lost, however if your mother has still difficulties swallowing I am wondering whether the speech pathologists have done proper swallowing tests prior to Tracheostomy removal?
It’s hard to say whether the new chest infection is coming from query aspiration or from stopping the antibiotics. It can come from either or from both. Overall, I believe stopping antibiotics is the right thing to do, as antibiotics can only ever be a temporary measure and not a permanent one.
The question really is whether your mother, at any given time has aspirated while eating and if she coughed and swallowed food into her lungs then the answer would be yes, however I’m sure that would have been witnessed?
Also, with having the steamy(Nebulising) oxygen mask on 24/7 doesn’t sound quite right to me. They can either give the Nebuliser intermittently(ever few hours) or what tends to be a much better option are the High Flow Nasal Prongs(http://www.fphcare.com.au/respiratory/adult-and-pediatric-care/optiflow/ ) .
They are nasal prongs that deliver humidified and heated oxygen and Patients generally love it. The hospital should have those nasal prongs, they have been around for many years!
- THE FAST LANE FOR PEACE OF MIND, CONTROL, POWER AND INFLUENCE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
It also tends to be very effective for Patients with lower oxygen levels and ventilation is often avoided by using them.
The constant nebulising(steaming) can be very effective as well, however is more uncomfortable. It’s better to constantly nebulise than going back on the ventilator.
I really think more chest Physio is absolutely necessary for your mother as well from what you are describing. That should be a no-brainer, really needs to be ongoing and should be a priority.
Chest Physio and mobilisation in combination with continuing to eat and drink would be a good way forward.
However with eating and drinking you really do need to be careful if your mother is weak and has no strong cough and has difficulties swallowing.
I also hope that your mother is getting out of bed regularly, because eating in bed just increases the risk of aspiration.
And you’re correct to point out that eating and drinking would get your mother stronger and better, however the risk of aspiration(=swallow stomach content or sputum into the lungs) needs to minimised if not excluded.
I would imagine that your mother has either an NG(Nasogastric) tube or PEG tube for feeding, however this can only be a temporary measure and your mother definitely needs to start eating again and the sooner the better!
She should have her nutritional needs met in the interim via the feeding tube and this can only be a temporary and not a long-term solution.
I know Ellie, you probably think this journey is never coming to an end, however you and your Mum have come a long way and sometimes setbacks happen.
Keep in mind your mother has been very sick and one thing that I learned over the many years in Intensive Care is that Patients recover in their own time no matter how much we all want to speed up the healing process.
Your mother’s body has been more or less traumatised through the long ICU stay, so she will need time.
However the biggest challenge at the moment is to keep your Mum out of ICU and not have the Tracheostomy go back in.
I also wouldn’t risk feeding her if she has indeed a weak cough.
I hope that helps Ellie!
Stay strong as you have been and even though your mother still has challenges, there is light at the end of the tunnel!
Let me know if you have any other questions!
Thank you& Kind Regards
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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!