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 Steve and the question last week was PART 5 of
My 73 year old Mom had a stroke and is intubated in Intensive
Care. She can’t come off the ventilator and the breathing tube, can she have a tracheostomy and go home and have INTENSIVE CARE AT HOME? (PART 5)
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 another 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 1)
Hi Patrik,
My dad is 71 he is in Critical care and last night we (Me, my Mom and my brother) were asked by the ICU doctors to decide if dad deteriorated further if we wanted to option one make him comfortable and he may not have made it through the
night
or
Option two let the doctors put him into an induced coma and on the ventilator/respirator.
Related article/video:
Option 2 is where he is now and I’m so scared that my dad at his age
and with his complications that he was admitted into hospital 8 days ago of lung cancer stage 4 complication of fever and infection and Pneumonia. He has been on treatment for 2 years for his cancer. And he has now rapidly deteriorated since admission to hospital after they did a bronchoscopy on his day 2 of admission.
Since he’s been in hospital he’s had further complications :
Any advice would be
welcome.
Many thanks
Veronika
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Hi Veronika,
thank you for sharing more about your Dad’s situation and thank you for being a client and using my 1:1 phone and email counselling and consulting service, I highly appreciate it!
A few more questions to get further clarify
your Dad’s situation
- Have you or other family members ever discussed with your Dad what he would want in such a situation? Does he even have an advanced care directive?
- Are you his medical power of attorney/ Next of kin(NOK) and do you have decision making authority
- Do you know if he’s on any inotropes/vasopressors? Inotropes/vasopressors are
intravenous medications such as Adrenaline/ Noradrenaline given for low blood pressure and they are considered life support and therefore can only be given in Intensive Care/Critical Care under monitoring
- What cancer treatment was your Dad on? I.e. Chemotherapy, Radiotherapy and/or did he have surgery for the cancer?
- Did he deteriorate after the Bronchoscopy and do you know if it was a factor of the deterioration?
- With your Dad’s pulmonary oedema, have they given you a reason why? Do you know if he also has a weak heart or do you know if he has kidney failure? Both might lead to pulmonary oedoma.
- You mention your Dad had a stroke. When did he have the stroke, this week? If he’s had a stroke they must have done a CT of the brain, do you know the results of the CT brain?
I hope my questions don’t overwhelm you, but the devil is in the detail and the more information the better and the better advice I can
provide.
This is a complex situation but that’s what most situations in Intensive Care/Critical Care look like and I will need to break it down for you so that you understand what’s really going on and how you can manage it.
Kind Regards
Patrik
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Hi Patrik
thank you for your reply
My father is being
given noradrenaline because he has low blood pressure the nurse just told me.
Yes, we have discussed his situation briefly and I am his power of attorney as his daughter. He has given instructions years ago about his
advance care to mum and I.
My father was having chemotherapy then immunotherapy and then back to chemotherapy. He had his cancer diagnosed October 2014 and had his right lower lobe of his lung removed in Feb 2015. He was on his 3rd line of treatment awaiting another trial drug due to be available around may.
Yes, I do believe he deteriorated after the
bronchoscopy it was meant to be quick and he has been in Intensive Care/Critical care since and the pulmonary oedema occurred the day after the bronchoscopy and then they said he has a weak heart at about 35%. We or he was never told about his weak heart before even the ICU doctors said they did not know this.
He suffered a stroke in Intensive care on Thursday morning, his cancer specialist said it happened because they were withholding
the blood thinners after the bronchoscopy. They then said he looks like he would make a near complete recovery from his stroke the day of it and after it, because he retained the strength in his arms and legs (left side was effected) his left side of face and his swallowing and talking is the
issue so yesterday they put him on a feeding tube at 1pm and he went downhill fast after with a fever and a new infection.
I saw him just now and we are waiting for the CT scan results of his head they did test this morning.
I will request copies of his tests also.
Thank you for your thoughts and time.
Veronika
Hi Veronika,
Thank you for your reply.
With your Dad having given advanced care directives to you and your Mum, what are those directives? Are they clear for Intensive Care/ Critical Care treatment?
Sometimes it’s very difficult to give
advance care directives for situations that may or may not occur in Intensive Care, because at the end of the day, you don’t know what you don’t know…
Also, even though a health professional might explain procedures, treatment etc… in Intensive Care for you, unless you have seen it many times, you don’t really know what it means. It’s really important to understand the pros and cons of all of the options laid out to
you.
As you can probably see by now already, most questions that arise when being treated in Intensive Care/Critical Care are not simple “Yes” and “No” answers but they require an evaluation of a much bigger picture.
Here are my thoughts with the information that you have given me thus far.
I do
believe that you have made the right decision by putting your Dad into an induced coma and on a ventilator.
Simply because you want your Dad in a position where you have a
say what might happen next. If they had stopped treating him yesterday, you would have lost control immediately.
If I was you, I would wait for the CT brain results and make every decision from there.
If his heart is “only” functioning at 35% they would be referring to his ejection fraction(EF), which is how strong the heart is beating. If it’s 35% it’s fairly weak and I’m not surprised he
went into pulmonary oedema. A weak heart is unable to cope with all the fluids going through the heart, therefore the heart is decompensating and fluids are pushing into the lungs, hence pulmonary oedema or “water in the lungs”.
Also, as far as the infection is concerned, it’s probably a side effect from the Chemotherapy/Radiotherapy. I would also be asking for his white cell count and his neutrophil count.
I would also suggest that we get on the phone ASAP as we are just scratching the surface here. I have worked in Intensive Care for nearly 20 years and you simply don’t know what you don’t know… I can “hand-hold” and guide you through this “once in a lifetime” experience that you don’t want to get wrong…
I can help you with asking the right questions so that you can always make an informed decision, get peace of mind, stay in control, keep your power and influence. Keep in mind that the Intensive
Care team is “managing” families of critically ill Patients 7 days a week/365 days a year and they know what to say, they know how to say it and they know what not to say…
There is a lot at stake on your end as well as from the ICU end. You want to get the best outcome for your Dad and the ICU wants to limit expenses and keep the stay in ICU as short as possible. Keeping the ICU stay short might also mean pushing for an early withdrawal of treatment which could ultimately lead to your Dad dying in a time frame that doesn’t align with your time frames.
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By getting your Dad in an induced coma, on a ventilator and on Inotropes/Vasopressors for his weak heart you have bought him precious time to see if he can recover or not.
Yes, stage 4 lung cancer is most likely life limiting but you don’t know how much time he’s got left and by buying
him this precious time you can give him more time.
Being aware of those dynamics is important and it help you getting bargaining power in what you want for your Dad!
