Hi, it’s 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, 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 in this series of questions from our client Robert and the question last week was PART 7 of

My 68 year old mother is in ICU with gastric perforation and she’s not “waking up” after the surgery! Will she need a tracheostomy? (PART 7)

You can check out last week’s episode by clicking on the link here.

You can find the previous questions answered from Robert here

PART 1, PART 2, PART 3, PART 4, PART 5 and PART 6

In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next question from our client Robert, which are excerpts from email counselling and consulting sessions with me and the question this week is

My 68 year old mother is in ICU with gastric perforation and she’s not “waking up” after the surgery! Will she need a tracheostomy? (PART 8)

Robert continues with his mother’s situation below

Hi Patrik,

It’s been a long day for me and the family.

First, a few quick answers/updates:

1. They closed the abdomen after the last surgery.
   
   

2. The oxygen support she is getting now (I think) is 60%.
   
   

3. They have indeed tried medications to increase urine output, but hasn’t helped much.
   
   

4. We had a small positive bump in urine production this afternoon, (up to 15mls/hour) but has since headed down from there.
   
   

5. We are seeing some swelling across her entire body (she looks “puffy”).  We were informed that this is related to the kidneys malfunctioning and not processing the fluid in the body appropriately. Not sure if there’s anything that can be done to help with the swelling or if we should be worried about it.
   
   

6. The blood pressure meds required to maintain her blood pressure are relatively low — they’re considering seeing how she does if they took her completely off of them.
   
   

7. She’s being provided nutrition via I.V. (not via the nasal tube).  The surgeon asked that we give the gut some rest since the surgery and not make it work too hard yet.
   
   

8. No fever for the last couple of days, and heart rate is stable as well.
   
   

9. No neurological response today

In talking to the doctors, they were very despondent today. They reiterated that she’s having issues with multiple organs, and the kidneys are the most concerning. They seem really, really worried and the prognosis that we’ve heard is that she has about 20-30% chance of making it through.

Now, we accept that she’s not doing well (and not looking well either).

But, her lead doctor earlier said that kidney issues are not uncommon a few days after surgery. And, the fact that we’ve seen some minor neurological-improvement is encouraging.

Your insights on the information provided would be much appreciated.

Kind Regards

Robert

Recommended:

• 1:1 email counselling and consulting with Patrik
  
  

• 1:1 phone and email counselling and consulting with Patrik

Hi Robert,

I’m very sorry to hear that things are not moving in the direction that you and your family had hoped.

Now I want to look at your updates first and quickly comment on some of those before I answer your other questions in detail.

1. They closed the abdomen after the last surgery.> good sign, you definitely want to have a closed abdomen, in some cases they do a stoma or leave the abdomen open because of high abdominal pressures
   
   

2. The oxygen support she is getting now (I think) is 60%.> good sign as you don’t want to ventilate on 100% for too long
   
   

3. They have indeed tried medications to increase urine output, but hasn’t helped much.> not overly surprised if the kidneys are slowly but surely failing
   
   

4. We had a small positive bump in urine production this afternoon, (up to 15cc/hour) but has since headed down from there.> 15 mls/hour is minimal
   
   

5. We are seeing some swelling across her entire body (she looks “puffy”).  We were informed that this is related to the kidneys malfunctioning and not processing the fluid in the body appropriately. Not sure if there’s anything that can be done to help with the swelling or if we should be worried about it.> The “puffiness” you’re seeing in your mother is related to low urine output, as well as being immobile for a relatively long period by now. The longer somebody is in a critical condition and an induced coma the higher the risk and likelihood of fluid retention in the skin. Imagine your mother not moving for many weeks now plus the deteriorating kidney function is a recipe for fluid accumulation and “puffiness”. There are a few things that can be done about it
   
   

   a) Haemodialysis I believe is almost inevitable by what you are describing and it could reduce the “puffiness” relatively quickly within 48-72 hours
   
   

   b) Your mother’s Albumin levels might be low. If Albumin is <25 in the blood tests, she may need some 20% Albumin infusion. A low Albumin contributes to being “puffy” because fluids basically “leak” from the arteries and the veins into the cells and can’t be pulled back because of low osmotic pressure.Therefore Haemodialysis to get rid of some excess fluids but also giving 20% Albumin if  Albumin levels are low are a good combination to reduce the “puffiness”. Also a low Albumin and not retracting fluids back into the veins and arteries may also contribute to a low-ish blood pressure

Related:

• The 5 Mistakes you are unconsciously making if your critically ill loved one is in an induced coma and is not “waking up”!
  
  

• The 10 answers to the 10 most frequently asked questions when your loved one isn’t “waking up “ after an induced coma!
  
  

6. The blood pressure meds required to maintain her blood pressure are relatively low — they’re considering seeing how she does if they took her completely off of them.> It’s always good if no inotropes/vasopressor for low blood pressures are required, however in light of potential acute kidney failure, achieving a mean blood pressure >65mmHg would be essential to keep the kidneys perfused from my experience
   
   

7. She’s being provided nutrition via I.V. (not via the nasal tube).  The surgeon asked that we give the gut some rest since the surgery and not make it work too hard yet.> fine, TPN(=Total parenteral nutrition or IV nutrition) will do for now, I have no concerns there. Giving the gut a rest is a good idea after abdominal surgery
   
   

8. No fever for the last couple of days, and heart rate is stable as well.> That’s a good sign and it maybe a sign that the Antibiotics are working and that the abdominal surgery is improving things as well
   
   

9. No neurological response today> Back to surgery means more sedatives and opiates. She’s also still fighting an infection, therefore she’s allowed to rest for now I suppose. I know you and your family have been waiting for your mother to “wake up” and it has yet to happen. I know how frustrating this is to wait and nothing is happening.

Again Robert, please be patient.

Your mother has been in and out of induced comas in recent days, especially with the abdominal surgery and the tracheostomy.

Therefore she has more sedation and pain killers in her body system than before.

Also, with acute kidney failure it takes even longer to excrete the sedatives and pain killers, therefore I would strongly advocate to start Haemodialysis for the kidney failure rather sooner than later.

Your friend

Patrik

PS: I only have one slot left for counselling/consulting left for this week, as I'm fully booked otherwise. Let me know if you want the one slot left by hitting reply to this email or by calling me on one of the numbers below before Friday August 11th, @9pm EDT/6pm PDT!