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 my client Veronica and the question last week was PART 2 of

My Dad (71) is in ICU with stage 4 lung cancer & stroke, he’s on the ventilator now and in an induced coma, what are his chances of survival? (PART 2)

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

In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next question from one of my clients Veronica, which are excerpts from phone and email counselling and consulting sessions with me and the question this week is

My Dad (71) is in ICU with stage 4 lung cancer & stroke, he’s on the ventilator now and in an induced coma, what are his chances of survival? (PART 3)

Veronica continues with her Dad’s situation below as follows

Hi Patrik,

My dad is so precious to me and I want to know I am doing everything I can to help him recover if possible. And to know everything possible is being done to help him whatever the outcome I need that reassurance he was cared for and given every chance to try to recover. My dad is a strong man mentally and physically he was extremely active even a few days before being admitted to hospital and he deserves the best care possible.

I am off to the hospital this morning and hope to get more information and dad’s bloods, his chest x-ray,  arterial blood gases and ventilation settings.

If you get this email please send the list of what else I need to find out.

Thank you

So much

Veronica

Hi Veronica,

It’s good to know that you have spoken to the Cardiologist and got his views.

It’s also good to know that your Dad is on Propofol and not on Midazolam.

Even though I believe an Angiogram would be good for clarity what’s happened with your Dad’s heart, the Heparin he’s getting would be prohibitive for an Angiogram as he’s at high risk of bleeding with the Heparin.

If Troponin levels are within normal range it minimises the risk that your Dad sustained a heart attack indeed. It might well be a stress Cardiomyopathy.

Hopefully that’s the case and the heart will go back to normal.

If your Dad aspirated, you should be asking for his chest x-ray results and arterial blood gases. I can help you interpret all of this and how it impacts on your Dad’s overall situation.

It’s a good sign that your Dad is responding to you, especially with the stroke from last week, I see this as a very good sign.

There are a number of things you should get updated on daily, just as we discussed yesterday. I can give you a whole list of updates you should be getting daily tomorrow.

It would also be good to know what ventilation settings he’s on.

When you go to the hospital, the following is important

• What sedation and how much sedation he’s on
  
  

• His ventilation settings and what’s their plan with ventilation, are they trying to wean him off the ventilator and get him out of the induced coma?
  
  

• Chest x-Ray results
  
  

• Blood results, especially infection markers such as White Cell count but also Haemoglobin, Platelet count and Neutrophils
  
  

• If he’s still on inotropes such as Noradrenaline
  
  

• What is his neurological response, I.e. is he responding, especially in light of the stroke from last week. In fact, find out what his Glasgow coma scale(GCS) is and I will talk you through what it means when we’re back on the phone
  
  

• Is his skin intact? Especially when being bed bound they need to manage his pressure area care
  
  

• Is he in a regular or irregular heart rhythm? Again with the ejection fraction low(35%) there is a bigger risk of the heart beating irregularly such as Atrial Fibrillation(AF)
  
  

• What is his blood clotting doing in light of the Heparin he’s getting? This is often stroke prevention therapy to keep the blood thin, but it shouldn’t be too thin

please find arterial blood gas parameters here

Normal levels are

• oxygen (PaO2): 75 to 100 mm Hg (10.5 to 13.5 kPa)
  
  

• carbon dioxide (PaCO2): 38 to 42 mm Hg (5.1 to 5.6 kPa)
  
  

• Arterial blood pH: 7.38 to 7.42
  
  

• Oxygen saturation (SaO2): 94% to 100%

The above are the most important levels when it comes to determining the effectiveness of mechanical ventilation

Other results they are getting from an arterial blood gas are

• Haemoglobin
  
  

• Potassium
  
  

• Lactate

Those results are not as important but they still give some indication of what else might be going on.

I hope this helps, please let me know what you need next.

That’s the most important stuff you need to know. Please give me a call anytime.

Or let me know what time you want me to call you.

Again, I can talk to the doctors/nurses when you are there too.

Recommended:

• 1:1 email counselling and consulting with Patrik
  
  

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

Hi Patrik,

Here are Dad’s  levels and results

Oxygen from ventilator 45%

Carbon dioxide on expired co2 is 32-35

Arterial ph 7.42

Oxygen saturation 100%

Haemoglobyn 106

Potasium normal

Lactate down now was slightly high

The nurse looking after dad said they still can not print any reports as their IT is trying to fix their printers atm.

I did not go back in as they can not give me copies until its fixed she said she will try to email the scan reports to me.

Thank you

Veronica

Hi Veronica,

Thank you for sending this through

Those numbers look all good.

I would still be interested to know his PO2 level. PO2 level is the oxygen level in the arterial blood and may actually vary from the oxygen saturation.

Especially with FIO2 from the ventilator still at 45%. The 45% oxygen level is still too high. For example, in order to wean your Dad off the ventilator, he needs to be on less than 35% of oxygen (FIO2) from the ventilator

The PO2 level actually determines if oxygen on the ventilator needs to be reduced or increased.

Also, with significant lung disease, PCO2(Carbon dioxide) levels can be increased as well and they look normal, which is good.

I would also be curious to know what other ventilator settings he’s on. Other parameters you may be asking for is PEEP and Pressure support. It would also be good to know if he’s doing some of the breathing himself or if the machine is doing most of the work.

Also, have a look at this article/video here so you can determine if they are doing all the right things to get your Dad off the ventilator.

• HOW TO WEAN A CRITICALLY ILL PATIENT IN INTENSIVE CARE OFF THE VENTILATOR AND THE BREATHING TUBE!

If for whatever reason they can’t wean your father off the ventilator and the breathing tube they may consider a tracheostomy in consultation with you, your Mom and your father if he’s getting more awake.

Have a look here to find out more about how long his breathing tube/endotracheal tube should stay in and whether he should or shouldn’t have a tracheostomy if they can’t wean him off the ventilator

• HOW LONG SHOULD A PATIENT BE ON A VENTILATOR BEFORE HAVING A TRACHEOSTOMY?
  
  

• How Long Can A Breathing Tube Or An Endotracheal Tube Can Stay In?
  
  

• Why Would A Critically Ill Patient In An Induced Coma Need A Tracheostomy In Intensive Care?
  
  

• WHAT ARE THE RISKS AND BENEFITS OF A TRACHEOSTOMY?

But overall his numbers, including Haemoglobin look pretty good.

No reason for “doom and gloom” at this stage.

A high lactate level can actually indicate an infection as well and if it’s normal that’s a rather good sign.

Happy to discuss over the phone whenever you want to