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Quick Tip for Families in Intensive Care: My Dad in ICU Died with Kidney Failure & Heart Disease, On Maximum Vasopressors, Did ICU Kill Him?

Today, I have an email from Karen who says,

“Hi Patrik,

My dad was sent to ICU for dialysis on the CRRT (Continuous Renal Replacement Therapy) machine to take off fluids. He’s congestive heart failure and his heart ejection fraction was at 30.

While at the hospital, they used Bumex/furosemide and drained his kidneys dry, which led him to be on dialysis. He was on vasopressors, like one bag, and they couldn’t wean him off. The vasopressors had to reach to 4 bags and the nurse said, the vasopressors were maxed out.

I feel like they killed my dad, and he had a low blood pressure that they said was getting lower and lower.

Has the ICU killed my dad?

– This is from Karen.”

My Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

Let’s digest and dissect Karen’s email. So, Karen’s dad was sent to ICU for dialysis on the CRRT, I should say, continuous renal replacement therapy, which is basically a dialysis machine to take off fluids. He has congestive heart failure, and his heart ejection fraction was at 30%.

Now, a normal ejection fraction is sort of 50 to 70%, a slightly reduced ejection fraction is 41 to 49%, and a low ejection fraction is less than 40%. So, your dad’s ejection fraction would have been on the low side. What is ejection fraction? By the way, ejection fraction, it occurs when the heart’s left ventricular stiffens and can’t fill properly with blood during the diastole, the heart’s relaxation phase. That’s what ejection fraction is. It basically means that the contractility and the pump function of the heart is significantly reduced in your dad’s situation most likely leading or contributing to kidney failure.

Then your email continues, “While at the hospital they used Bumex, which is also known as furosemide or Lasix, and drained his kidneys dry, which further led him to be on dialysis.” Yes, that is very likely because if you use too much furosemide or Bumex or Lasix, it usually increases creatinine and it’s drying the kidneys out too much leading further into kidney failure. It’s like creating a vicious cycle if you’re using too much of it.

Then he was on vasopressors, one bag to begin with, and they couldn’t wean him off it. They then had to increase the vasopressors to 4 bags, and the nurse said he was maxed out on vasopressors.

So, what are vasopressors? Vasopressors, generally speaking, are vasoconstrictors which means that they’re constricting the veins and the arteries to centralize blood closer to the heart, to increase blood pressure, and to ideally also improve organ perfusion. The major vasopressors include phenylephrine, norepinephrine, epinephrine, and vasopressin. In other countries, they’re also known as adrenaline, noradrenaline, and vasopressin. Inotropes fall into the same category. They’re usually known as dopamine, dobutamine, and milrinone.

Now, if those inotropes and vasopressors did not work, it means that his heart and his circulation were failing regardless at this point. His body may not have been able to recover, and that would have shown. For example, in blood results, it would have shown in lactate results in particular, because organs were no longer profuse, which would have increased the lactate level. So, that’s why it’s so important that you let an expert look at the medical records to confirm your hypothesis.  Your email concludes with, “I feel like they killed my dad. He had a low blood pressure that they said kept getting lower and lower.” Now, it is really difficult to say without looking at the medical records whether they killed your dad or not. What is important here is, you need to evaluate all aspects of his care and treatment in ICU.

Whilst you’re giving some good insights here, everything needs to be looked at. What was leading up to your dad’s ICU? Was he treated on a hospital ward? Were they potentially missing things on a hospital ward? Also, with his severe heart and kidney failure, and the way they managed his fluids and medications, it simply may have pushed his body beyond what it could handle.

Again, we would be able to find that out in a medical record review by looking at kidney ultrasounds, heart ultrasounds (Echocardiogram), lung ultrasounds, CT (Computed Tomography) scans of the heart, CT scans of the lungs, CT scans of the kidneys, assuming they would have done all of that as part of his treatment course.

I have seen many patients recover from congestive heart failure and low ejection fraction, assuming they can get the right level of treatment early on by giving them dobutamine, milrinone, dopamine, sometimes levosimendan as a one-off to increase ejection fraction.

In this instance, his heart was already struggling to pump his blood effectively, plus the added-on complexity that the Bumex, the furosemide, the Lasix, which are strong diuretics, with the goal to aggressively remove fluids. It simply may have dehydrated him too much, which like I said earlier, would have worsened his kidney function and caused low blood pressure or severe hypertension. This would have made it even harder for his heart to pump blood to other organs.

So then, they used the vasopressors, like I said, and they are used to keep circulation going. Unfortunately, still, they kept increasing the vasopressors and the inotropes, and he still wasn’t stabilizing. It meant that his heart and circulation was simply failing, and his body could no longer recover.

I can feel the pain in your email, feeling like the ICU’s actions played a role in letting your dad die. First question is, do you feel like they didn’t listen to your concerns or pushed treatments that weren’t right for him? Did you do your research early on? Why did you not ask for help when it all happened? This is the major downfall for most clients, for most families in intensive care. They don’t ask for help early enough. They ask for help when it’s too late. That’s certainly is the case here. The bottom line is that whenever we help clients in intensive care early on, they get results. We have saved so many lives over the years for our clients and for our patients in intensive care.

Now, 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 by going to our testimonial section at intensivecarehotline.com and you can verify that on our intensivecarehotline.com podcast section, where we have done client interviews because our advice is absolutely life changing. It is absolutely life-changing, assuming it’s coming in real time.

Now, in this situation, with Karen’s email, we can, of course, do a medical record review and help Karen with some closure, or potentially launching a lawsuit, or suing the hospital for negligence. But we would know whether there has been negligence or not until we have looked at the medical records. Whereas if we have access to medical records in real time, then we can help in real time because our advice is absolutely life changing.

That’s why I do one on one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. You can join a growing number of members and clients that we have worked with over the years, getting results when they have a loved one critically ill in intensive care by advising them correctly, by giving them a second opinion, and by advocating for them all the way.

I talk to you and your families directly. I talk to doctors and nurses directly, on your behalf or with you. 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, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. When I talk to doctors and nurses directly, or when I advise you what questions to ask, you will see the dynamics will change in your favor pretty quickly.

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 or if you need closure.

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 get exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. All of that will help you to make informed decisions, have peace of mind, control, power, and influence.

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

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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