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Quick Tip for Families in Intensive Care: My Husband’s in ICU with Pancreatitis, He’s Off the Ventilator, Is He Getting the Right Treatment?

If you want to know how to treat pancreatitis in intensive care for your husband or for your critically ill loved ones, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecarehotline.com and I have another quick tip for families in intensive care.

Today, I have an email from Fatima who says,

“Hi Patrik,

 My husband has been in ICU since last Monday. He has pancreatitis, so his pancreas has caused an infection in his body. He was on a ventilator for 3 days, then he came out of ventilation and the induced coma. He looks very confused but does remember me. They are giving him the antibiotics. My question is how long will it take for him to get better? From, Fatima.”

Well, Fatima, thank you so much for asking that question. Well, the good news here is your husband has come out of the ventilation and induced coma within 3 days with the pancreatitis. That is really good. That is really a quick turnaround.

The reason is probably a little bit confused is as a side effect from the induced coma. What that means is he would have been receiving propofol or midazolam/Versed or Precedex, and/or morphine and fentanyl, and that knocks the body out because he would have been in a lot of pain as part of the pancreatitis.

When anyone with pancreatitis goes into ICU, it means it’s a severe case of pancreatitis. What happens in intensive care with pancreatitis, there’s always a case for complications to happen.

So, it sounds to me like whatever treatment they’ve given him, whether it’s antibiotics, they kept him nil by mouth, most likely. They might have given him some IV fluids because aggressive hydration with IV fluids is crucial to maintain blood pressure and prevent organ failure during pancreatitis.

Like I said, strong pain management are often needed such as opiates, fentanyl, and morphine. One of the main side effects of fentanyl and morphine during pancreatitis is respiratory depression. If someone is on a ventilator, they don’t need a side effect of respiratory depression because that could inhibit someone getting off the ventilator, and I’m glad to hear that your husband is off the ventilator already.

So, with pancreatitis, most patients are needed nil by mouth. So, if your husband is not allowed to eat, well, especially if he’s on a ventilator, he can’t eat anyway. They may receive a little bit of nutrition by a feeding tube like nasogastric or nasojejunal tube or IV nutrition, also known as TPN (Total Parenteral Nutrition). Most likely he would have had TPN. Most patients in ICU with pancreatitis are nil by mouth, which excludes nasogastric tube or nasojejunal tube feeding.

In many cases, like in your husband’s case, ventilation is needed. Mechanical ventilation with the breathing tube is needed and thank God, it only took 3 days.

Now, also, because pancreatitis can cause sepsis and septic shock in those situations, kidneys are failing or can be failing. Kidneys are failing, sometimes, it is sufficient to manage with IV fluids in combination with some diuretics such as furosemide or Lasix, and sometimes dialysis or hemofiltration is needed. You haven’t mentioned any of it, but you got to keep an eye on that. Sometimes, there’s a delay in the kidneys shutting down.

With pancreatitis as well, especially with the septic or a septic shock picture, blood pressure support is needed, such as medications like vasopressors or inotropes might be needed if blood pressure drops too low and there’s a high chance your husband may have needed or may still need vasopressors and inotropes such as Levophed, norepinephrine, noradrenaline, phenylephrine, epinephrine, adrenaline. The names vary depending on which country you’re in, or dobutamine or dopamine or milrinone even.

So, what needs to happen here? Underlying causes need to be treated, such as gallstones. If pancreatitis is caused by gallstones, a procedure, ERCP (Endoscopic Retrograde Cholangiopancreatography) or surgery may be needed. It doesn’t sound to me like your husband had surgery. You’ve mentioned that antibiotics are used, if an infection is suspected, sometimes drainage or surgery is needed for infected pancreatic necrosis. You haven’t mentioned any of that, but you’ve got to ask whether parts of the pancreas are potentially dead.

Another thing that often happens during pancreatitis is that patient’s go with high blood sugars because the pancreas no longer can produce and excrete the insulin needed to regulate blood sugars. So, find out if your husband has had some insulin or potentially is still on some insulin to manage high sugars.

Also, what has triggered the pancreatitis? Is it alcohol? Is it medication induced pancreatitis? You may want to find out.

So, what are complications and how to manage them? Pancreatic necrotic, or is it a pseudocyst? If the tissue or fluid collections form, drainage procedures may be needed. Like I said, sepsis or systemic inflammatory response syndrome, also known as SIRS, if the inflammation spreads leading to multi-organ failure, ICU care focuses on stabilizing vital signs, hemodynamics ventilation in the body. It sounds like that has happened already.

Really, recovery depends on the severity of the condition and how the body responds to treatment. But what is really important that your husband is already off the ventilator, that is really important to know, and that means, hopefully he’s turned the corner.

What are the next steps from here? The next steps from here is to start nutrition again, whether TPN continues for a few more days and then maybe you can start to eat and drink slowly, or maybe nasogastric tube or nasojejunal tube feeds are necessary, that you will see over the next few days.

Also, ask if he is now insulin dependent for now. Because he’s confused, make sure he gets back to normality as quickly as possible, which includes going to have a shower, at least having a good bed wash, getting out of bed, sitting out of bed, walking around, even if he can do that, if he’s stable enough, brushing teeth. Just go back to a routine as quickly as possible because he’s come off the ventilator, do deep breathing exercises, coughing exercises, so that he’s not going to need ventilation again.

If he’s still on some oxygen wean, oxygen off. Those are all important things that need to happen.

Then hopefully, you can go back to a hospital ward and leave intensive care as quickly as possible. This could take a few days, maybe even a couple of weeks. Pancreatitis is not to mess around with. It’s quite a severe infection, especially if it required an intensive care stay.

So, that is my quick tip for today. I hope that helps, Fatima.

I have worked in critical care and nursing for 25 years in 3 different countries, where I worked as a nurse manager for over 5 years, and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very, very confidently say that we have saved many lives with our consulting advocacy. I can verify that for you if you go to intensivecarehotline.com, if you look on our testimonial section, and you can see what our clients say, and you can also verify that on our intensivecarehotline.com podcast section where we have done client interviews.

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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.