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Today's article is about, “COPD (Chronic Obstructive Pulmonary Disease) Patient on Ventilator: Doctor Says No Options & Placed on Hospice - Is There Hope?”

You may also watch the video here on our website https://intensivecarehotline.com/ventilation/copd-chronic-obstructive-pulmonary-disease-patient-on-ventilator-doctor-says-no-options-placed-on-hospice-is-there-hope/ or you can continue reading the article below.

COPD (Chronic Obstructive Pulmonary Disease) Patient on Ventilator: Doctor Says No Options & Placed on Hospice - Is There Hope?

My name is Patrik Hutzel from intensivecarehotline.com, where we instantly improve the lives for families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power and influence, making sure your loved one always gets best care and treatment, even if you’re not a doctor or a nurse in intensive care.

So today I have an email from one of our clients, Christy, who says,

Hi Patrik,

My mother is diagnosed with COPD (Chronic Obstructive Pulmonary Disease) and requires use of an oxygen machine at home. She had complained and began panicking from not being able to catch her breath three days ago, and she’s now on a ventilator in ICU. She was admitted for extreme shortness of breath. O2 sats was in the 50s. They sedated her and placed her on a ventilator 3 days later. The doctor expressed there are no other options, placed her on hospice and are doping her up with sedatives and propofol and morphine until she dies from organ failure.

Is there really nothing else we can do? Please help us ASAP before they kill my mom. I need to know we did all we could for her.

From Christie.

So, Christy, I’m so sorry you and your family are going through this incredibly difficult and frightening situation with your mother. This is exactly the kind of critical situation where you need expert guidance right now, not later. A lot of families in intensive care underestimate timelines, I think they have time.

Well, you don’t have a lot of time in intensive care, you’re dealing with a lot of, with a once in a lifetime situation that you simply can’t afford to get wrong.

Now, there are options, never give up. First, let me be very clear, just because one ICU doctor says there are no options doesn’t mean that’s actually true. I’ve seen this scenario play out hundreds of times over my 25+ years critical care nursing experience in 3 different countries where I worked as a nurse manager for over 5 years in intensive care, and I’ve been consulting and advocating for families in intensive care all around the world since 2013.

And families are told there’s nothing more we can do. Often find that with the right advocacy, with the right questions, with the right expertise, with a different mindset, there are other options. Also keep in mind what the ICU team is not telling you that, between 70 to 90% of intensive care patients survive, so the odds are in your mom’s favor, so why would she be in the smaller bracket of patients of not surviving, it’s a critical question you need to ask yourself.

So, other critical questions that need answers immediately. Why did they wait 3 days to intubate your mother? If her oxygen saturation was in the 50s on admission, that’s a life-threatening emergency. Was there a trial of non-invasive ventilation like BiPAP (Bilevel Positive Airway Pressure) first?

What happened during those 3 days? Did they do arterial blood gases?

Next, what are her actual ventilator settings right now? Is she on high oxygen requirements? What’s her PEEP (Positive End Expiratory Pressure)? What’s the mode of ventilation? These details matter enormously. Has she had a proper trial of ventilation? 3 days is not enough time to determine if someone can recover from a COPD exacerbation. Many COPD patients need 7 to 14 days or longer on a ventilator to recover.

Again, the biggest challenge for families in intensive care is 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. They don’t even know that managing them is an option. But we can help you with that.

Next, what triggered this exacerbation of COPD? Was it pneumonia, a viral infection? Was it heart failure? Was it a pulmonary embolism? The underlying cause matters for treatment and prognosis. What does actually no other options mean? No options for what? For ventilation weaning, for recovery, for long-term management, this is far too vague.

Next, why hospice so quickly? Was there a proper family meeting? Did they explain her actual prognosis with treatment versus without? Or are they making assumptions about quality of life? More importantly about perceived quality of life, because quality of life is no more than a perception. We’re not talking about reality here, we’re talking about a perception. And it’s their only option after 3 days to suggest hospice. That’s simply not good enough.

And you have to ask yourself, is your mother in a perceived or in a real end of life situation? What’s the difference? I’m glad you’ve asked. A real end of life situation is a situation where nothing will save your mom’s life right now. No treatment, no medications, no surgery, no life saving equipment, no nothing will save your mom’s life and she’s about to die right now, and nothing will change that.

Sounds like your mom is in a perceived end of life situation. There’s a perception that your mom might die, they’re painting you the doom and gloom picture, they don’t want you to have hope. And that’s a perceived end of life situation, and they will move heaven and earth to move your mom to hospice and kill her with sedatives and opiates. That’s a perceived end of life situation, it’s also euthanasia if you are letting this happen, and euthanasia is illegal. Euthanasia is the hastening of death and it’s illegal and it’s happening every day in ICU all around the world. No one addresses the elephant in the room.

So, and it’s your fault if you let that happen. Sorry to be so blunt, I have to break the news. Everything that happens in ICU that you let happen, by letting your loved one die, if treatment options are there, then it’s your fault of, letting it happen because you have leverage if you get the right advice and if you ask the right questions.

Now let’s look at the sedation and morphine issue. Here’s what concerns me most about your mom’s situation. They’re sedating her with propofol and morphine while she’s in hospice, which will absolutely lead to organ failure and death. So again, that’s where the euthanasia part is coming in. Could also be perceived as murder. But is this because she genuinely has no chance of recovery or because they’ve made that decision without a proper trial of treatment? Or do they need the ICU bed? Is that why they’re giving you the doom and gloom and the death narrative? And it clearly points towards that your mom is not in a real, but in a perceived end of life situation.

When someone is heavily sedated and given morphine in hospice in ICU they’re essentially creating a self-fulfilling prophecy. The sedation and morphine suppresses breathing, reduces blood pressure, and yes, will inevitably lead to organ failure. But your mom deserves a fighting chance first.

What you do need to do right now, get access to all medical records immediately, you need to request and obtain all of your mother’s medical records from this hospitalization. Admission notes, progress notes, ventilator flow sheets, lab results, imaging reports, everything. You have the right to access any of those medical records, whether you’re in the U.S., in the UK, in Ireland, in South Africa, in Australia, it doesn’t matter. Do not let anybody talking you out of your right to get access to medical records. And you need them to actually make informed decisions. Having access to all medical records is absolutely critical because without them nobody, including myself or any expert, can give you accurate guidance on what’s really happening and what options truly exist.

Next, schedule an emergency consulting call with myself, you need to speak with me or my team at intensivecarehotline.com immediately, not tomorrow, not next week, but today. Here’s why we can review the medical records with you right now. We can help you understand what’s really happening with your mother. We can participate in a consulting call with you and the ICU team to ask the right questions, challenge assumptions, and advocate for your mother. We can identify if there are treatment options that haven’t been explored. We can help you determine if this hospice decision is appropriate or premature, and I can almost guarantee you that after 3 days, it is inappropriate and premature.

Next, a consulting call with the ICU team where we’re involved changes everything. Doctors respond very differently when they know an ICU advocate and ICU professional is asking questions and advocating for the family, we know what questions to ask, what treatments to push for, and how to navigate these situations.

Next, request a palliative care meeting, not hospice yet. Tell the hospital you want a formal palliative care consultation, not hospice, but a palliative care consultation. This gives you expert symptom management while still pursuing treatment. It also gives you a second opinion on prognosis.

Next, ask about these specific options. Proper ventilator weaning trials, has she had spontaneous breathing trials, what were the results, treatment of the underlying cause, if it’s an infection, is she on appropriate antibiotics, if it’s heart failure, is she on diuretics? Steroids for COPD exacerbation, this is standard treatment. Is she getting them? Transferred to another facility if this hospital has given up, another hospital might be more aggressive, might be more positive, might be more hopeful.

Next, tracheostomy. If she does need prolonged ventilation, a tracheostomy can be more comfortable and help weaning. It also eliminates the need for sedation and morphine straight away. Another long-term option is Intensive Care at Home. And most ICU teams won’t tell you about it, but it could be a game changer for you and for your mother. Have a look at intensivecareathome.com. If your mom does need long-term ventilation and or a tracheostomy, she doesn’t have to stay in ICU indefinitely or go to traditional nursing homes, they wouldn’t take her anyway.

I also argue with your mom being at home with COPD and on oxygen, she could have benefited from Intensive Care at Home to begin with. She probably would have not gone to hospital in the first place, because Intensive Care at Home is a long-term option that can keep your mother out of ICU predictably and permanently while receiving the ventilator support she needs. Many COPD patients with tracheostomies and home ventilation live for years with a good quality of life, avoiding repeated ICU admissions. This option means she can be home with family, she gets specialized nursing care, she can have her ventilator managed at home, she avoids the infections and complications of long-term hospitalization. Most importantly, she stays out of ICU predictably and permanently, but right now, before we even discuss long-term options, we need to make sure she gets a fair chance at recovery first.

The bottom line I’ve seen far too many families told there’s nothing more we can do, Christie, only to find out later that there were absolutely other options. 

They just didn’t have the right advocate asking the right questions and putting pressure on the ICU team because your mom deserves a proper trial of ventilation, more than 3 days, treatment of the underlying cause of this exacerbation, a clear explanation of her actual prognosis with aggressive treatment, time for her body to respond to treatment. And of course expert advocacy from someone who knows ICU medicine and ICU nursing inside out, and that’s what we provide here at intensivecarehotline.com, and then also the option of Intensive Care at Home.

So, take action now. We offer emergency consultations for exactly these types of situations. Don’t let them rush into a decision about life or death. 3 days is not enough time, even 3 weeks and sometimes 3 months is not enough time. To determine if a COPD patient can recover from an exacerbation requiring mechanical ventilation, we’ve helped hundreds if not thousands of families in your exact situation, and many of those patients not only survived but went home and lived or live a good quality of life. Some need tracheostomies with home ventilation, which is where we come in with intensivecareathome.com. But they’re alive and with their families. Always keep in mind you have options, you have rights, your mother has rights, and you deserve answers. Go and exercise them right now.

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

And because our advice is absolutely life-changing, 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. And that’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

And that’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives. And that’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. And I talk to you and your families directly. I handhold you through this once-in a-lifetime situation that you simply cannot afford to get wrong.

And when I talk to families directly, I also talk to doctors and nurses directly, asking 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. 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, so. If, in case 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, 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 e-books and 21 videos that I’ve personally written and recorded. And all of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment, always.

And 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 support at intensivecarehotline.com with your questions. And 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, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have from this video.

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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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