Hi there!
Today’s article is
about, “Can My Husband in ICU Have a Tracheostomy Whilst Having a Gastrointestinal (GI)-Bleed? Quick Tip for Families in ICU!”
You may also watch the video here on our website https://intensivecarehotline.com/ventilation/can-my-husband-in-icu-have-a-tracheostomy-whilst-having-a-gastrointestinal-gi-bleed-quick-tip-for-families-in-icu/ or you can continue reading the article below.
Can My Husband in ICU Have a Tracheostomy Whilst Having a Gastrointestinal (GI)-Bleed? Quick Tip for Families in ICU!
If you want to know if it’s a good idea to have a tracheostomy for
your loved one in intensive care while they’re having an active GI bleed, stay tuned. I’ve got news for you.
My name is Patrik Hutzel from intensivecarehotline.com. I have another quick tip and question answered for families in intensive care for you today.
I have an email from one of
our clients who has their loved one in intensive care on a ventilator. He’s been sick for a long time with multiple comorbidities, and he’s now got a GI bleed. He’s been ventilated for about 3 weeks now with a breathing tube and there have been delays with doing a
tracheostomy because he’s got an active GI (Gastrointestinal) bleed, and he’s got his hemoglobin dropping. Hemoglobin means the red blood cells. He needs multiple blood transfusions almost daily. Should someone in intensive care have a tracheostomy if they have a GI bleed and significant hemoglobin drop.
So, let’s look at the email that we’ve sent to our client.
“Hemoglobin and hematocrit are monitored after CT (Computed Tomography) angiogram of the abdomen shows an active bleeding. The latest of which is that hemoglobin increased to 8.2 from 6.8 after 2 units of blood transfusion. Day before, he had a hemoglobin of 5.4. Really, really low and requiring more blood transfusions.
The team will continue to monitor the hemoglobin and hematocrit, and for signs of active bleeding. There was also questionable bloody stool overnight.
The Interventional Radiology did mesenteric angiography as well. There is no active bleeding noted. However, there were suspicious areas, but they did not persist. According to the Interventional Radiology, GI bleeds
are often transient and vasopressor support can clamp down a vessel enough to stop it/obscure it. No embolization was done. The Interventional Radiology signed off and can be reconsulted when needed.
To sum it up, if the hemoglobin and hematocrit continues to decline significantly, they will repeat the CT scan angiogram to check again for a bleeding. They need to look again into the
suspicious areas they mentioned in the report.
Your husband remains on high ventilation support settings: FiO2 of 70%, PEEP (Positive End-Expiratory Pressure) of 8. Ideally, the FiO2 from the ventilator should be in the lower value prior to the tracheostomy. The tracheostomy should be done once he is more stable and FiO2 (Fraction of Inspired Oxygen) should come down to less
than 40% ideally to do a tracheostomy safely.”
Now, here’s the other risk doing a tracheostomy when there’s active bleeding in the abdominal and rectal areas. Well, the risk that another bleed occurs when someone is having a tracheostomy, because it’s a surgical procedure, is high and that could become life-threatening pretty quickly.
You have to weigh up the pros and the cons. Whilst the good news about having a tracheostomy is that sedation and opiates can pretty much be stopped straight away. The question is, how big is the risk for another bleed?
Then, our client’s husband could deteriorate even further, needing multiple vasopressors and inotropes, multiple blood transfusions, making his condition even more unstable and then delaying the
tracheostomy even further.
It’s a difficult question to answer and it needs to be discussed obviously with the ENT (Ear, Nose, and Throat) surgeon who might do the tracheostomy, or some intensivist might do the tracheostomy, percutaneous tracheostomy. It needs to be thoroughly discussed and evaluated with the anesthetist as well if needed and make a thorough risk assessment what the next step
is.
I believe waiting maybe a couple of more days until the bleeding has subsided and is more stable, might be a better idea than doing the tracheostomy the day after having had the C T angiogram done. That is just my suggestion here. We looked at the medical records. We’ve been looking at the medical records for this client for a long time now, for every day where we give our take.
I’ve worked in
critical care for nearly 25 years in critical care nursing, where I also worked as a nurse manager for over 5 years. We’ve been consulting and advocating since 2013 here at intensivecarehotline.com.
We have saved many lives with our consulting and advocacy. You can verify that on our testimonial section. You can also verify on our podcast section where we have done many client interviews, and you can hear what our clients are saying there.
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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.
