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Quick Tip for Families in Intensive Care: My Husband’s in ICU with DVT (Deep Vein Thrombosis), PE (Pulmonary Embolism), and Pneumonia on BIPAP (Bi-Level Positive Airway Pressure), Can He Be Taken Off the Ventilator?
Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
Today, I have an email from Maria who says,
“Hi Patrik,
It feels like I’m not having a say in my husband’s care when I think that things are not being done properly in ICU. He has been on the ventilator, and I see that he has pneumonia infections as well as MRSA (Methicillin-resistant Staphylococcus aureus), pulmonary embolism, DVT (deep vein thrombosis), a gallbladder infection, and the list goes on.
They have not tried to take him off the ventilator and on a BIPAP (Bi-Level Positive Airway Pressure). They’re telling me that his setting is at 35 to 40%, that he’s breathing mostly on his own 18 breaths per minute.”
Well, I’m glad you’re reaching out Maria, and the thing is, if he has a pneumonia, he might need the BIPAP. Because what the BIPAP does, it helps him expand his lungs and that will help with pneumonia assuming they’re targeting with the right antibiotics, antifungals, or antivirals, depending on what level of infection, as it says MRSA. So, he might be on vancomycin for the MRSA.
Also, if he’s got a pulmonary embolism, he might need some heparin, he might need a heparin infusion. That might also compromise his cardiac function as well as his breathing ability. So, it might be justified at the moment that he’s still on the BIPAP. Now, the question for me is this, is he on a BIPAP with a breathing tube or with a tracheostomy or just with a BIPAP mask? You haven’t shared that yet, so the devil is often in the detail.
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.
So, the problem here is that some things are unclear and they’re probably very unclear for you as well. You haven’t probably asked the right questions, as yet.
If he has a gallbladder infection, most likely he’s also nil by mouth. He can’t have any nutrition for that potentially and he might need some TPN (total parenteral nutrition) or intravenous nutrition. It really depends on how they’re going to treat the gallbladder infection.
So, there’s a number of issues here, and him being on the BIPAP might just be what he needs for a few more days because that will help him with pneumonia. Because a pneumonia often means there’s collapsed parts of the lungs and the BIPAP will help open up those collapsed parts of the lungs while it’s clearing up the pneumonia, hopefully with antibiotics and so forth.
Now, it looks like he’s got a number of issues; DVT, pulmonary embolism, that goes hand in hand, both are caused by blood clots. Like I said, he’s most likely on a heparin infusion. Also with the BIPAP, he should have some arterial blood gases to see whether the BIPAP is actually helping him with a good gas exchange i.e. if his O2 (oxygen) is up or PCO2 (partial pressure of carbon dioxide) is down.
So, there’s a number of things that need to be looked at. Also, what does his chest X-ray show? Is the chest X-ray clear? Is it clearing up? Those are very, very important questions that you need to ask. What is this oxygen saturation like? Can he cough up his secretions? Does he need some suctioning? Like I said, is the BIPAP being delivered with a mask? With a breathing tube? Or with a tracheostomy? That’s what it comes down to here.
So, I hope that helps and answers your questions.
I have worked in critical care for nearly 25 years in three different countries. I have been consulting and advocating for families in intensive care since 2013. You can verify the work that we’ve done on our testimonial section. We have saved many lives with our consulting and advocacy.
I have also worked as a nurse manager in intensive care for over five years prior to starting my own consultancy and advocacy practice here at intensivecarehotline.com. We have also done some client interviews at intensivecarehotline.com if you look on our podcast link and video link, we have done client interviews who verified the work that we’ve done for them where we’ve saved lives as well.
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You can’t afford getting this once in a lifetime situation wrong. When you have a loved one critically ill in intensive care, you can’t leave things up to chance and that’s exactly what we’re here for you to do.
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Thank you so much for watching.
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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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