Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

Quick Tip for Families in Intensive Care: My Mother’s in ICU with Cardiac & Kidney Failure, The Doctors Say They Can’t Do Cardiac Surgery, Help! 

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

Today, I have a question from Heidi who says,

“Hi Patrik,

My mom is in kidney and heart failure, she does dialysis four times a week. Yesterday, she had a heart catheter done and we were told that she needs an open heart surgery. Now, the doctors are saying that he is too scared to do the surgery. Also, she has no immune system to fight off any infections. Should I be scared? What will happen without the surgery?”

So, if your mom is in heart failure, the question is why is she in heart failure? So, she had a heart catheter done, which is also known as an angiogram. The question is, what have they found? They might have found some blocked arteries which is often the indication to do a heart catheter or an angiogram in the first place.

If they found blocked arteries, they can do a few things to unblock arteries that supply the heart with oxygenated blood. First thing they can do is dilate the blocked arteries and see whether they can be opened up or number two, put a stent in or also known as a PTCA (percutaneous transluminal coronary angioplasty) and then open up the coronary arteries that way. If they put in a stent, your mom would need to be anticoagulated after the stent with high doses of aspirin or something like Plavix (clopidogrel) or sometimes warfarin.

If they can’t do either dilation or a stent, they might suggest open heart surgery, or coronary artery bypass grafts. Now, when they do coronary artery bypass grafts, your mom would need to be stable. The question is, again, what led to this in the first place? Did she have a heart attack or is she potentially having cardiomyopathy? So, the question is what led to this? Now, if the heart is weak, the heart muscles are damaged because of the blockages or because of cardiomyopathy. She might be indeed too weak, too frail to go for open heart surgery.

So, what are options here? Options might be to put her on an intra-aortic balloon pump also known as IABP, that can sometimes help to stabilize the heart before cardiac surgery and also after cardiac surgery. Now, if the heart is having a poor ejection fraction, the heart muscle is weak, contractility is poor, then also she might need ECMO (extracorporeal membrane oxygenation). ECMO is also taking over the function of the heart for a period of time to give the heart time to recover, and that can also help to get patients on to cardiac surgery or it also helps ECMO sometimes to get patients on a heart transplant.

Now, in terms of she has no immune system, I don’t know why. Why does she have no immune system? Is she fighting something else that you haven’t shared here? Is her white cell count low? Is she neutropenic? What is leading to her immune system being compromised? It certainly doesn’t help when going for surgery and your immune system is compromised, that certainly doesn’t help. Also, with a weak heart, that also doesn’t help the kidneys. If the heart is weak, can’t maintain the blood pressure, that means the kidneys aren’t being perfused which could also be an issue, which means she will probably stay on dialysis.

Now, what else is happening here? If the heart is weak, she’ll probably be on inotropes or vasopressors such as noradrenaline, norepinephrine, epinephrine or adrenaline, dobutamine, dopamine, milrinone, levosimendan might help here to strengthen the heart, but those are medications that can only be given in intensive care and should only be temporary.

So, I hope that explains to you, but I would also strongly encourage you to dig deeper with the cardiologist and the cardiac surgeon and find out the exact reasons why they don’t want to do open heart surgery. Also, there could also be an issue around valve replacements or valve repairs that need to be done. You’re saying she needs to go for open heart surgery. Open heart surgery, generally speaking, is coronary artery bypass grafts or valve replacements or repairs. So, go and find out!

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

That’s also why we created a membership for families of critically ill patients in intensive care and 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, sharing all my 2.5 decades worth of intensive care nursing experience with you, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

I also do one-on-one consulting and advocacy over the phone, Skype, Zoom, 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 can’t afford to get wrong. I also talk to doctors and nurses directly on your behalf if you want me to and 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.

I also represent you in family meetings with intensive care teams with the goal to make sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

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.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or 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 or what questions and insights you have from this video, and share this video with your friends and families.

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

If you want your questions answered really fast in a video, leave a donation on the YouTube super chat button and I will get to your email in the next couple of days. I still have emails sitting in my inbox from last year. We are now in July 2024, so I’m barely keeping up. You can also leave a small donation or a big donation depending on the value you think you get from these videos, and it will help us to make as many videos as possible and helping as many families in intensive care as possible.

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.

Related Articles:

Quick Tip for Families in Intensive care: Is Ventilation Necessary After Tracheostomy? Quick Tip for Families in ICU: Should I Let Go of my Dad with Cancer on a Ventilator & Tracheostomy? Quick Tip for Families in ICU: 3 Things You Need to Pay Attention to for COVID ARDS in ICU! Quick Tip for Families in ICU: How to Get Information in ICU Fast! Quick Tip for Families in ICU: What is Considered Progress While Ventilated with a Breathing Tube?