Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we INSTANTLY improve the lives of Families of critically ill Patients in Intensive Care, so that you can have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from our readers and the question last week was PART 6 of
MY AUNTY IS IN INTENSIVE
CARE ON ECMO FOR ARDS, WE’RE VERY WORRIED SHE MAY DIE! HELP! (PART 6)
You can check out the answer to last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer another question from one of our readers and the question this week is PART 7 of
MY AUNTY IS IN INTENSIVE CARE ON ECMO FOR ARDS, WE’RE VERY WORRIED SHE MAY DIE! HELP! (PART 7)
Lee from the UK writes
Hi Patrik,
we've been back to the hospital today my auntie is still stable oxygen levels 35-40%, arterial blood gases still ok the dialysis machine was off today because of the end of the cycle.
They are putting it back on later
today.
They were also taking some samples in the last few days and there was indication of infection in the line from the dialysis machine.
So they are putting new lines in as well. They’ve also taken blood samples to see if there's something underlying that has been either not detected or gone
missing.
If the lungs have been damaged during high oxygen level blasts, my aunty required at first and this is what's causing the lungs to keep holding fluids or to be leaking fluids can this be rectified?
Would this have been detected by now? Would we have been informed of this? Would lung damage to the walls of the lung be able to be seen by x-ray, or camera/bronchoscopy?
Can they open her up to find the problem, and can this be reversed? We have not spoken to the ECMO team at the minute, because we feel we've come away from that a little for the time being and we will speak to them soon.
I have spoken to the ECMO team from London to query whether a patient can have a 2nd blast after 7 days and they confirmed this can be done in some certain cases.
Also low platelets count is not a problem, although I'm sure her reading last week was 90 and today's was 140.
Her white blood cells are not too low and are not a concern either. It seems the sole
concern is clearly the fluid getting back in the lungs and we really want to know why?
Thanks Lee,
Hi Lee,
I think, judging by your last couple of emails, your aunty is improving!
If she now has been on 35-40% Oxygen requirements and if her blood gases are good, that’s very encouraging.
Again, oxygen requirements above 65% and high
CO2(carbon dioxide) levels are an indication for ECMO.
Getting a line infection from either a Central line or a
Vascular catheter(used for Dialysis) is nothing unusual and as long as they have identified it and are changing lines and screen the old lines, it sounds to me like they are doing the right thing there.
It would most likely be difficult to ascertain why the lungs still keep holding fluids. It’s part of having ARDS, however her relatively low oxygen requirements indicate that she’s
stabilising.
The damage of the walls in the lungs can most likely be detected by doing a bronchoscopy, however this is an unnecessary risk at this stage I would think and once again, I can only emphasize that things move extremely slowly in Intensive Care when critically ill.
The last couple of days with the oxygen requirements and the blood gases being stable show slow progress. Take this as a positive sign.
Your aunty might be plateauing for a while before she is making progress
again.
If your aunt’s lungs are going to fully recover it will be over time and not in an instant. It won’t be like switching on a light switch and it’s more liking switching on a light with a dimmer.
To “open” her up would be a big risk and ARDS/ Pneumonia or lung failure is always treated conservatively, meaning that surgery is not really an option.
Therefore you need to give it time. Be patient, things don’t happen quickly in ICU with ARDS.
If you have read Ellie’s
questions you would have seen that her mother was in ICU for many weeks, I think 3 months in total.
As I have hinted towards yesterday, you might as well be at the beginning of a long journey.
Given that her white cell count is down and given that Platelets are back to normal is encouraging as well!
There are no quick fixes in ARDS and sorry that I keep repeating myself here, you need to be
patient and you need to give it time. I know that's easier said than done and it's the only option.
Your aunt is not going backwards, 30-40% oxygen requirement is pretty good in ARDS and if the lungs recover, the fluids in the lungs will take care of themselves.
Recommended resources:
They’ve got to keep on the Dialysis machine and if the sole concern is the fluids on the lungs, then that in a sense is encouraging because your aunt is
not battling anything else.
A big challenge in ARDS can be if other organs are failing too. Given that’s not the case from what you’ve described , give your aunt the time to let her lungs heal.
No matter how much we all want to speed up the recovery of a critically ill Patient in Intensive Care, they take their own time and your aunt will recover in her own time.
Make sure that she gets good nursing care as well, things like regular washes, regular turns and regular mouthcare can do wonders as
well.
Make sure you stay well informed, as you have been!
Stay strong and patient and keep doing what you are doing. Small steps and often 2 steps forward and 1 step
back.
Let me know how things go.
Your friend
Patrik Hutzel
Skype ID
patrik.hutzel
phone 415- 915-0090 in the USA/Canada
phone 03-
8658 2138 in Australia/ New Zealand
phone 0118 324 3018 in the UK/Ireland
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Patrik Hutzel
Critical Care Nurse
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