My name is 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, control, power, and influence, even if you’re not a doctor or a nurse in intensive care, making sure your loved one always gets best care and treatment.

In today’s video, I’m answering a question from one of our clients, Paul, who says.

“Hi Patrik,

 It was really nice to talk to you. We have just reversed the DNR (Do Not Resuscitate) for my brother, thank you so much for your advice, and we also requested them to try hemofiltration instead as you suggested, instead of dialysis. How long do you think my brother will be having the hemofiltration? The nephrologist is not present there right now, so I will talk to him tomorrow during the day to do the dialysis with 50 or 25 mls or so. We are trying to avoid a tracheostomy after the heart attack, but he’s not waking up yet. I will keep you posted, please check the medical records also and let me know if you don’t see what you’re looking for. Thank you so much.

From Paul.”

Paul’s brother overseas in ICU had a heart attack, and Paul wants to know, “How long will my brother need the hemofiltration?”. Hemofiltration is a different word for dialysis. He’s also concerned about avoiding a tracheostomy and the fact that his brother isn’t waking up yet. Let me dive straight in and answer Paul’s important question.

Understanding dialysis duration or hemofiltration duration in ICU after a heart attack.

First of all, Paul, I’m really glad we could help you reverse the DNR the do not resuscitate order, and get the ICU team to consider hemofiltration instead of regular dialysis. That was a critical step forward and most of you watching this, you don’t even believe you can reverse the DNR you don’t even believe you can save your loved one’s life in ICU. We’ve done it hundreds of times here at intensivecarehotline.com. We’ve helped so many families reversing DNRs. We’ve helped so many families saving their loved one’s life, and that’s all documented on our testimonial section and on our intensivecarehotline.com podcast where we’ve done client interviews.

Regarding your question about how long will your brother need the hemofiltration, it really depends on several factors, and here’s what you need to understand.

What are the factors that determine dialysis or hemofiltration duration?

Acute kidney injury recovery. When someone has a heart attack in ICU their kidneys often take a hit because of reduced blood flow and circulation. The good news is that many patients with acute kidney injury can recover kidney function over time. The duration of dialysis really depends on how severe the kidney injury is, and whether the kidneys start recovering. One way for the kidneys to start recovering after a heart attack in particular is by simply increasing the contractility and the pump function of the heart because most likely your brother went into kidney failure because the blood pressure dropped because your brother had a heart attack. That means the kidneys weren’t getting enough perfusion. Hopefully as he recovers and probably also gets inotropes and vasopressors to increase the contractility and increase the pump function and increase the blood pressure, hopefully kidney function will recover.

Also, the type of dialysis matters, so the fact that you’re now asking the nephrologist to consider hemofiltration, which is also known as CRRT or continuous renal replacement therapy, with slower rates like 25 to 50 mL is brilliant. This much gentler approach compared to dialysis is much better tolerated in critically ill patients, especially after a heart attack, when the cardiovascular system is already stressed. Regular intermittent hemodialysis can cause drops in blood pressure which your brother doesn’t need right now.

Next. Timeline for kidney recovery.

In many cases of acute kidney injury in ICU patients might need dialysis or hemofiltration for anywhere from a few days to several weeks. Some patients recover kidney function completely and come off dialysis entirely. Others might need temporary support for weeks or even months. A smaller percentage might unfortunately need long-term dialysis if the kidney damage is severe or irreversible.

Also, what’s important, your brother’s heart function. Since your brother had a heart attack, his heart function plays a huge role here. If his heart recovers and can pump blood effectively again, this will help his kidneys recover too. The heart and kidneys work together, and when one struggles, it affects the other. He also needs an ultrasound of the heart or a transesophageal ultrasound, a TOE, to determine his ejection fraction. Ejection fraction will help you understand how well his heart is pumping, the contractility, which will affect kidney function or the recovery of such.

Ejection fraction might also be supported temporarily with inotropes and vasopressors such as noradrenaline, norepinephrine, epinephrine, adrenaline, dobutamine, dopamine, milrinone, maybe a dose of levosimendan.

Let’s also look how to avoid a tracheostomy after the heart attack.

You mentioned wanting to avoid a tracheostomy, and I completely understand that concern. However, here’s what you need to know.

1. Why do ICU teams consider a tracheostomy? Typically, if a patient has been intubated on a breathing tube for more than 10 to 14 days, the ICU team starts thinking about a tracheostomy. The reason is that a tracheostomy is actually more comfortable for the patient, reduces sedation, requirements, makes weaning off the ventilator easier, and reduces the risk of complications like vocal cord damage or vocal cord paralysis. It is not always avoidable if your brother isn’t waking up yet and still needs the ventilator. A tracheostomy might actually be beneficial rather than harmful. It doesn’t mean he’ll never come off the ventilator, it just makes the weaning process safer and more comfortable.

Next, waking up takes time. After a significant heart attack, especially if there was a period where the brain didn’t get enough oxygen, waking up can take time. The ICU team will be reducing sedation and opiates carefully to assess his neurological status, but this process needs to be done cautiously.

One of the most important questions, Paul, you need to ask here is what are they doing to move him towards extubation, i.e. removing the breathing tube. That’s one of the most important questions you can ask. And number two, ask them what are they doing beyond the shadow of a doubt to extubate him and what are they doing beyond the shadow of a doubt to try and avoid the tracheostomy. Very important questions.

You also mentioned that you’re sending me medical records, which is great, and I cannot stress enough how absolutely critical it is to have access to all medical records when we’re dealing with complex ICU cases like your brother’s.

Here’s why these matters.

We get the complete picture. Without seeing the full medical records, I can only give you general advice and guidance, but when I review the actual charts, or when me and my team are reviewing the actual charts, I can see exactly what medications he’s on, his pathology and lab results, what his heart function looks like, what ventilator settings he’s on, medications he’s on, and the list goes on, fluid balance, every little detail is important, doctor’s notes, nurses’ notes, and so forth.

Having all the records allows us to do informed advocacy, and then we can get on a consulting call with you and the ICU team where we can ask all the right questions, challenge assumptions if needed, remind them of your rights, and advocate effectively for your brother.

It’s also important that you question the ICU team. During our consulting calls, we help families like yours understand what questions to ask the ICU team, what alternatives exist, like you did with hemofiltration, for example, and like you did with reversing the DNR which most families in intensive care get absolutely walked all over. They don’t even know that it’s possible to reverse the DNR and how to ensure your brother gets the best possible care and treatment.

Here’s what you should do next.

Speak with a nephrologist. When you talk to the kidney doctor tomorrow, ask specifically about what are the kidney function trends, what’s the plan for weaning dialysis, can they use gentler settings like 25 to 50 mls an hour with hemofiltration, what’s their assessment of kidney recovery potential.

Get a neurological assessment. Since your brother isn’t waking up yet, you need clarity on, has he had a CT scan or MRI scan of the brain, what do the neurologists say about his brain function, are they doing EEGs to check for seizure activity, is he potentially on anti-seizure medication, what’s their timeline for expecting him to wake up.

What I’m going to tell you now is really important for you to consider as well.

If your brother ends up needing long-term ventilation, a tracheostomy, or potentially palliative care, there’s an option many families don’t know exists, and that is Intensive Care at Home, and you can get more information at intensivecareathome.com.

This is a long-term solution that can keep your brother out of ICU predictably and permanently if he needs ongoing ventilation and or tracheostomy support. Many patients who need long-term ventilation or who have a tracheostomy can actually be cared for at home with the right support and equipment. This gives them a better quality of life, familiar surroundings with family, much lower risk of hospital acquired infections, more personalized care, and significant cost savings for health insurance’s funding bodies and so forth, and it gives the ICU an empty bed, which is what they desperately want and need.

Go and check out intensivecareathome.com for more information. Whether your brother needs ongoing ventilation support or even palliative care, Intensive Care at Home, provides options hospitals often can’t provide and don’t tell families about.

How can we at Intensive Care Hotline help you right now?

Paul, you are doing an amazing job advocating for your brother, and I want you to know that intensivecarehotline.com is here to support you every step of the way.

Here’s how we help. One on one consulting over the phone, zoom, WhatsApp, whichever works best for you. When you schedule a consulting call with me or with one of my team members at intensivecarehotline.com, we review all of your brother’s medical records in detail, then we help you understand what’s really happening, what questions to ask, and how to advocate effectively.

We do conference calls with the ICU teams. We can join calls with the ICU team to ask the hard questions, clarify confusing information, and ensure your brother gets best care and treatment options he deserves, just like we did with getting hemofiltration considered. Most families don’t even know that’s possible. It’s about managing ICU teams so they don’t manage you.

ICU crises don’t happen on a schedule, that’s why we’re here and available to support families when they need it the most.

We have a proven track record. We’ve helped thousands of families navigate complex ICU situations, reverse DNRs, avoid premature withdrawal of life support, and get their loved ones the best care and treatment. We’ve saved so many lives. You can verify that on our testimonial section at intensivecarehotline.com and on our podcast section at intensivecarehotline.com

If you’re in a situation like Paul’s where your loved one is in ICU and you’re getting conflicting information, feeling pressured or you just don’t know what questions to ask, reach out to us immediately. Do not wait until it’s too late. The decisions you make in ICU are literally life or death decisions. You cannot afford to get this wrong, and having an expert ICU advocate in your corner changes everything.

I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients in intensive care. You can verify that on our intensivecarehotline.com testimonial section and also on our intensivecarehotline.com podcast section where we have done client interviews.

Because our advice is absolutely life changing, it is absolutely life changing. That’s why you can join a growing number of members and clients that we’re helping in intensive care. We’re improving their lives instantly, making sure families in intensive care can make informed decisions, have peace of mind, control, power and influence, making sure their loved ones get best care and treatment always.

Because the biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. That is exactly what you’re up against.

That’s why I do one on one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. When I talk to doctors and nurses directly, which I do as well, you would see the dynamics change in your favor very quickly because you have someone on your team that understands intensive care inside out.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time, so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org  directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 ebooks and 21 videos that I have personally written and recorded that only our members have access to.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families and comment below what you want to see next, what questions and insights you have from this video.

I also do a weekly YouTube live where I answer your questions live on a show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel, or if you are a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com.

Thank you so much for watching.