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Quick Tip for Families in Intensive Care: What’s the Link Between Lung Scarring and Intubation?

If you want to know the difference between lung scarring and intubation, 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.

So, today I have a question from Peter who was asking, “Is there a difference between lung scarring and intubation?”

Now, let’s do a breakdown of the terminology first. Lung scarring basically means that there’s scarring of tissues in the lungs, which is also basically stiffening the lungs because the lungs have basically lost all elasticity, which is important for a gas exchange, i.e. oxygen to go into the lungs and carbon dioxide to come out. That could impact on the breathing ability of a patient. Intubation means the insertion of a breathing tube into the mouth or into the nose for mechanical ventilation. So, that’s the terminology.

Is it linked? Well, let’s look at that in more detail today. So, lung scarring and fibrosis can be linked to intubation in a few ways, mainly due to the effects of prolonged mechanical ventilation and underlying conditions that may worsen during intubations.

Here’s how they connect: Ventilator-induced lung injury, which means mechanical ventilation can overstretch the lung if the pressure or volume is too high, causing inflammation and microscopic lung damage. Over time, this damage can lead to pulmonary fibrosis, and pulmonary fibrosis is actually lung scarring.

Next, oxygen toxicity. High levels of oxygen for long periods can cause oxidative stress, damaging lung tissue, and promoting scarring.

Next, being intubated, infections, and pneumonia. Being intubated increases the risk of ventilator-associated pneumonia, also known as VAP, which can lead to inflammation and fibrosis in the lungs. Again, fibrosis leads to lung scarring. Chronic or repeated infections can cause scarring as part of the healing process.

Next, pre-existing conditions. If a patient already had lung disease, i.e., pulmonary fibrosis, which means scarring already is pre-existing, COPD (Chronic obstructive pulmonary disease), intubation might worsen their condition. Some patients develop post-ARDS (acute respiratory distress syndrome) fibrosis if they had severe respiratory distress. ARDS stands for acute respiratory distress syndrome, also known as lung failure.

Lastly, prolonged intubation without weaning. If someone remains ventilated too long without successful weaning, their lungs may become stiff and less able to function independently. This can make extubation or transitioning to a tracheostomy more difficult. What it all comes down to is that if there’s lung scarring happening during intubation? Would that lead to the inability to wean off the breathing tube and the ventilator? Would that lead to a tracheostomy?

If it leads to a tracheostomy, what’s the outcome there? Would that lead to ventilation weaning or would it mean that with a tracheostomy a patient can be ventilated for a prolonged period without weaning? And for example, go home then leave ICU with a service like Intensive Care at Home and you can find more information at intensivecareathome.com.

The question also is, what ventilator settings is the patient on? Do they have already high oxygen requirements, high PEEP (Positive end expiratory pressure) or high-pressure support? What other pressures are we looking on the ventilator? For example, the mean pressures, are they high? Are they above 30 for example, which then increases the risk for the pneumothorax, i.e. Barotrauma or a hole in the lungs? Because the pressure in the lungs is high and they pretty much pop. So, all those risks need to be assessed.

For example, do you then need to reduce the pressure that someone is being ventilated with? If the pressure is reduced, will that be giving sufficient ventilation? Is that delivering sufficient gas exchange? Are arterial blood gases then maintained within a physiological level, i.e., is PO2 (partial pressure of oxygen), PCO2 (partial pressure of carbon dioxide) within normal ranges? Is SPO2 (oxygen saturation) above 95% and so forth?

So really, what is the end game here? But if people want to live even if they have scar tissue or pulmonary fibrosis, they should have a tracheostomy assuming they can’t be weaned off the ventilator. Then they can go home with a service like Intensive Care at Home.

So, I hope that answers your question.

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

Because our advice here is absolutely life changing, and once again, it is life changing quite literally because we have saved so many lives. You can join a growing number of members and clients that we have helped over the years. If you sign up for one-on-one consulting with me, I do one-on-one consulting over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses 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, 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, and you will see that when I talk to doctors and nurses directly, or when I represent you in family meetings with intensive care teams, you will see that the dynamics will change in your favor because as professional advocates, we know how to hold intensive care teams accountable and get results and outcomes for our clients.

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 get exclusive access to 21 e-books and 21 videos that I have personally written and recorded that will help you to make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

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].

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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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