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 from one of my clients and the question in the last episode was
The ICU doctors told me that my mom’s condition is getting worse. How should I respond to this?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next questions from one my clients Sharonwho has her 64 year old mother transferred
in the Intensive Care due to severe difficulty in breathing and alteration in mental state. Ultimately, her mother was diagnosed with liver failure and is on blood pressure medications and may subjected to dialysis due to renal failure.
My mother needed a breathing tube and is now in an induced coma, how can she get out of it?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Sharon here.”
PART 1
PART
2
You can read the 1:1 consulting and advocacy session here.
Sharon: Hello?
Patrik: Oh, hi. Is that Sharon?
Sharon: Hello?
Patrik: Hi, Sharon. It’s Patrik-
Sharon: Yeah, this is Sharon.
Patrik: … from Intensive Care Hotline.
How are you?
Sharon: Hi. I’ve been better.
Patrik: I’m sure you-
Sharon: How are you?
Patrik: I’m very well. Thank you. So … Yeah, go on.
Sharon: I just spoke to the ICU, just to give you the timeline of what happened.
My mother, I guess she has cirrhosis (liver disease), which we didn’t actually know,
and I guess her doctor started to see some kidney complications and wanted her to go to the hospital on Saturday, and she didn’t tell us that. We ended up calling 911 and we took her up the hospital.
Related information about haemodialysis:
Patrik: Yep. Yep, I’ve got that.
Sharon: On Sunday, she went into septic shock. They kept saying it was an infection or whatever, but they got her out of it. They managed her blood pressure, got it back up to normal without medication. She was doing better, but then all of a sudden her lungs started to … She started to have trouble breathing, and then it became like a lung issue. They didn’t know what it was. It could
be pneumonia, and then it was like … we had… where… she started become too disorientation. She started to not be as conscious as she had been. She was eating and everything, and so … And she wasn’t in the ICU at all after that she was in a
step-down.
And so they decided that while she was still in that state to put a breathing tube (Intubation) in so they could start figuring out … and it was really like …
infectious disease came, and they found no infections. Until last night which she had no temperature whatsoever. Her blood pressure was remaining stable, all of this stuff, and then all of a sudden today … and her kidney function was going up and
down, but she was still producing urine. And today in the ICU, she stopped producing urine. We consider that kidney failure, but we’re not going to do dialysis yet. We’re going to do something they put in her neck.
Related articles/videos:
Patrik: Oh, yeah. The central line.
Yeah, the central line (CVC). Yeah.
Sharon: Right. And then, her blood pressure, they took her off of the medicine and after… so they had had her on eight, and then 15, the medicine.
Patrik: Do you know what medicine that was?
Sharon: She had some medicine (Inotropes) to artificially raise her blood
pressure.
Patrik: Okay. Yeah, it would have been norepinephrine or epinephrine, most likely, and that’s also why they would-
Sharon: I think it’s the first one you said.
Patrik: Right, the norepinephrine. Yeah, most likely. And that’s sort of why they had
to put the line in the neck, because you can’t give that medication without the line in the neck. So anybody-
Sharon: Oh no, she had already had that line in her neck. This was for something different. This was a different procedure where it’s kind of like a dialysis, but not a dialysis. Just to do one function of dialysis, just to flush out the fluids and decrease the inflammation.
Patrik: They’re doing that? Okay. And how long have they been doing that for?
Sharon: They just put it in today.
Patrik: Okay. And have they started her on the dialysis yet?
Sharon: No. It’s not full dialysis.
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Patrik: Yeah, I know. I know.
Sharon: It’s just this other stuff.
Patrik: I call it dialysis. I know
it’s not dialysis. It’s just, if we keep talking about this, we can call it dialysis or hemofiltration. Doesn’t matter what we call it.
Sharon: That. Yeah, yeah.
Patrik: Hemofiltration?
Sharon: I heard something they called it.
Patrik:
Hemofiltration.
Sharon: Because they just put that in today. They just put that in today, and that’s kind of where we are right now, and I just don’t … It just seems like every time she’s getting better, they do something and then it gets worse.
Patrik: Yeah. Now, I really want to … and I’ve just gone through my emails again before I
called you, with your question, is there any glimmer of hope? Look, the problem in ICU is families don’t have perspective. To answer your question, yes, there’s definitely hope. 90% to 94% of intensive care patients leave intensive care alive. That’s the vast majority. Our patients-
Sharon: Even with multiple organ failures?
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Patrik: Absolutely.
Sharon: Hello?
Patrik: Yes, I’m here. Can you hear me? Can you hear me?
Sharon: Yeah. I know that my mother’s cirrhosis (liver disease) is complicating a lot in the fact that we didn’t know about it, and that’s caused the kidney thing, and that’s what … It just seems like every day it gets worse. She only went into the ICU yesterday.
Patrik: Oh, I see. I see. So it’s only basically ICU admission yesterday, and then they put her in the induced coma-
Sharon: Yeah.
Related information about induced coma:
Patrik: Okay. So that’s all very fresh, very … Okay, I didn’t
get that from your email. Okay. Good that you mentioned it. Look, this is-
Sharon: No, she was in step-down up until yesterday, and the reason they put her in the ICU is because they felt like … Her breathing was stable, but they were afraid that it wouldn’t stay that way, that she was getting tired and less alert, so they wanted to put a breathing tube in just in case she got too tired to breathe.
But look, at that point everything was about her lungs. You know what I mean? And they were focused on this inflammation in her lungs. Then
they did a test where they stuck something down the breathing tube, and I think a lot of the stress of all these tests impacted her blood pressure.
Patrik: Yes, but also … The stress doesn’t help, but anybody who’s going to be induced into a coma will drop their blood pressure, and the reason for that …
Most of the medications that are given for an induced coma, as a
main side effect, they have hypotension. Hypotension basically means low blood pressure. So a lot of people, even without multi-organ failure, who are induced into a coma will lower their blood pressure, and they will end up on the norepinephrine at
least intermittently. So, so far what you’ve described is nothing unusual in ICU terms.
Sharon: Okay. Yeah, because I mean they said they weren’t even giving her that much sedative, but I can’t imagine that … They must be giving her a fair amount, because they’ve done all these procedures on her. I can’t imagine they wouldn’t give her a fair amount.
Patrik: Well, especially with the camera that they put … especially with the check on her lungs, where they did … You’re probably most likely referring to a bronchoscopy that she had, right?
Sharon: Yeah, that’s what I’m referring to.
Patrik: Right, right. With a bronchoscopy, she would have had a fair amount of sedation. There’s no doubt about that. The other
thing-
Sharon: Right, so wouldn’t that have implications on her blood pressure?
Patrik: Oh, absolutely. Absolutely. No doubt about that.
Sharon: Right. So it just is surprising to me that they’re so grim about that now, if that’s an expected sort of … You
know?
Patrik: What sort of… What they are grim? Is that what you said? They are grim about it?
Sharon: I mean; I feel like they’ve been very grim. I know it’s a good hospital, but I do feel like they, today … And I think they mentioned that thing that I sent you, that link, which has horrible statistics associated with it.
Patrik: So let me-
Sharon: Is there anything that you can tell me about that?
Patrik: Basically, yes. Especially with her lungs as well, I’ll tell you what I believe happened from the start. Basically, we see hepatorenal failure (liver and kidney failure). With the kidneys failing, she would have
accumulated fluids in her lungs at some point, because the first place where the fluids are going, if the kidneys aren’t working, is the lungs. That’s the first organ that’s going to be affected when the kidneys are failing. So that also then makes it more likely to develop a pneumonia. Again, that’s what I mean. I know this sounds horrible to you-
Sharon: Which she doesn’t have.
Patrik: Okay. She doesn’t have-
Sharon: She doesn’t have the pneumonia.
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Patrik: Good.
Sharon: They did all the infections tests. The infections team has come. They’ve done multiple things. They can’t find anything. They keep coming back over and over again. Nothing has grown. But then she also spiked a temperature last night.
That went
back to normal, but she hadn’t had a temperature once since we brought her in.
Patrik: That’s good. That’s good, but especially if she had fluid on the lungs (Pleural Effusion),
that’s just a side effect of the kidneys failing. Does that make sense?
Sharon: Right.
Patrik: Right?
Sharon: Yes.
Patrik: The other thing, when I read through the link … and I’m well aware that anybody
with liver failure, often the only option is to do a liver transplant, but I also believe this is way too early to talk about that … but what I really want to explain to you as well is you’re talking about the grim outlook. I really need to hone in on that. When families come to us, their number one complaint is that ICU teams are negative and they are doom and gloom and they are grim. I hear it every day, and I know that because I’ve worked in intensive care for nearly 20 years, and it’s so important to
put this in perspective for you.
Patients in intensive care are … most of the time, they’re as close to death as they would ever be during their entire lifetime. There’s no doubt about that, right?
At the same time, what I mentioned to you earlier, 90% to 94% of intensive care patients survive, right?
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information:
Sharon: Right.
Patrik: So an ICU will never say to a family, “Oh, we’re definitely going to cure your mother. She’ll definitely be out of ICU in the next two weeks,” or whatever time frame they may put on it. It’s not going to happen.
They will never promise you anything that they can’t keep. They will always be negative, so you’ve got to read between the lines. You need to read between the lines. That’s so important.
The other thing in that context that’s really important to know is, the worst case scenario from an ICU perspective is that your mother is going to occupy a bed there for the next four weeks. That’s their worst case scenario because there’s such a high demand
for ICU beds, right?
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Sharon: Right.
“Thank you very much for being a part of the previous series of 1:1 consulting and advocacy sessions. We hope you will find these new upcoming episodes informative and empowering.
Kind Regards
Patrik
