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

My sister is gone, because the doctor had ultimately decided not to resuscitate my sister without my permission!!

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 a new series of questions from one my clients Sharon who 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 went on dialysis due to kidney failure.

My mother is suffering from a severe liver illness and has been taken in the ICU for close monitoring and intensive medical care management. What can I do to help her?

Hi Patrik,

My Mom has liver disease, cirrhosis . She hid the diagnosis from us. A week and a half ago she went to the doctor and he told her to go to the hospital because her kidney function was affected, she never told me or my dad. By Sunday we called 911 and she was considered in shock her blood pressure was so low. They got her stabilized and she started to recover. Then, they moved her room and suddenly she couldn’t breathe, it got worse every day as did her mental state so they decided to move her to ICU and give her breathing tube (endotracheal tube) to figure out lung problems.

Related article:

• How Long Can A Patient Stay In Intensive Care?

They thought was ARDS (lung failure) but is was fluid, but after the breathing tube now her blood pressure dropped again and kidney function is worse. They gave catheter to drain fluid in the lungs and meds to get blood pressure up again.

Obviously this is all caused by her liver disease but it seems like every decision they make is wrong.

Thanks

Sharon

Find more information about lung failure and breathing tube:

• My Mum has been in ICU for three weeks now and she is on ECMO for ARDS! Will she survive? 
  
  

• How Long Can a Breathing Tube or an Endotracheal Tube Can Stay In?

Hi Sharon,

thank you for sharing more about your Mom’s situation.

Have they screened her for an infection?

Have they started her on dialysis  for the kidney failure?

For example, low blood pressure can be caused by an infection but is often a side effect of the induced coma.

Kind Regards

Patrik

Related article:

• What Are the Side Effects of an Induced Coma?

Hi Patrik,

Where do they put the blood into?

They also told us they think she is in the last day of her life.

Sharon

Hi Sharon,

With the information that you have shared, I have not seen any evidence of this.

Again, do not get bogged down by their negativity and keep questioning and challenging them.

Recommended:

• 5 POWERFUL THINGS YOU NEED TO DO IF THE INTENSIVE CARE TEAM IS NEGATIVE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
  
  

• “PEACE OF MIND, CONTROL, POWER AND INFLUENCE EVEN IN THE MOST CHALLENGING OF CIRCUMSTANCES THAT YOU, YOUR FAMILY AND YOUR CRITICALLY ILL LOVED ONE COULD POSSIBLY FACE IN INTENSIVE CARE!”

The next step for you is to ask for a meeting ASAP.

Kind Regards

Patrik

Hi Patrik,

They have been non-stop screening her for infections and everything keeps coming up negative its driving us nuts.

No dialysis they said all they need to do right now is drain fluid so no need for full dialysis yet.

They did not put her in induced coma. Just sedated her. And they said they lessened the sedation. Her blood pressure was stable for days and only went down when they put in the breathing tube. That said she was also talking and eating and then the day that stopped was when they put in tube.

Sharon

Hi Sharon,

Thank you for clarifying your Mom’s situation Sharon.

Induced coma and sedation  tend to be interchangeable terms.

Related and recommended articles:

• What’s The Difference Between An Induced Coma And Sedation?
  
  

• “PEACE OF MIND, CONTROL, POWER AND INFLUENCE EVEN IN THE MOST CHALLENGING OF CIRCUMSTANCES THAT YOU, YOUR FAMILY AND YOUR CRITICALLY ILL LOVED ONE COULD POSSIBLY FACE IN INTENSIVE CARE!”

For now, my advice is to be patient. Things in Intensive Care are often a marathon and not a sprint.

Also It’ll be very important for you to keep asking good questions as this will help position your Mom’s diagnosis, her prognosis, as well as her care and treatment.

If you don’t position and don’t ask questions, the Intensive Care team will do it for you and they do it with their own agenda in mind.

Also, how old is your mother?

Kind Regards

Patrik

Recommended:

• Book you free consultation call here

Hi Patrik,

My mom was just started on Norepinephrine and Epinephrine. How long does it take to get the blood pressure up?

Sharon

Hi Sharon,

getting the blood pressure up in Intensive Care or critically ill Patients needs to be looked at from various different angles.

Blood pressure has most likely dropped for a number of reasons and not only for one reason.

The reasons contributing to low blood pressure or hypotension would have been

1. The critical illness and the liver failing
   
   

2. The induced coma and some of the sedatives and opiates (pain killers)
   
   

3. The potential for infection or sepsis which I still believe can’t be ruled out at this stage
   
   

4. The mechanical ventilation
   
   

5. Low blood volume (hypovolaemia). I know your mom is in kidney failure but she still might be slightly dehydrated, depending on where the fluids are (i.e. in the lungs or in the body cells as opposed to the blood vessels)

Having a low blood pressure for critically ill Patients in ICU can never be looked at in isolation and must always be looked at from different angles and the contributing factors.

In order for your mom to get her blood pressure up, she needs to be

1. On inotropes/vasopressors such as Norepinephrine or Epinephrine
   
   

2. Needs to have sufficient blood volume in the veins and arteries to maintain a sufficient blood pressure
   
   

3. Treat any sepsis or infection
   
   

4. Minimize sedation and the pain killers

I hope this isn’t overwhelming, but again many issues coming up in Intensive Care cannot be looked at in isolation because the body is a finely tuned machine.

At this stage from what you have described and shared, a low blood pressure is a concern, but the kidneys not working and the liver failing is a much bigger concern for now.

In Patients with healthy kidneys and no induced coma and mechanical ventilation, a low blood pressure can be treated just with giving fluids.

Giving fluids in your Mom’s situation might fix the blood pressure, but could damage the lungs because the kidneys aren’t working.

Therefore, they most likely will weigh up what is most important at this point in time.

For example: by putting your mom on Hemofiltration they will remove fluids and probably reduce her blood pressure even further. This can be managed with the Norepinephrine.

Every action in ICU can have drastic consequences for other body systems and therefore, the answer to your original question is really that it depends and what is the current priority.

I believe the current priority are the kidneys and getting the hemofiltration going to reduce the fluids on the lungs. This will increase the chances to get your mother off the ventilator, reduce the need for sedation and get the blood pressure up.

I hope this isn’t overwhelming you.

Again, Intensive Care treatment and critical illness is a marathon and not a sprint.

Any questions please let me know.

Kind Regards

Patrik

Hi Patrik,

Are there any questions I should ask today?

Sharon

Recommended:

• 1:1 email counselling and consulting with Patrik
  
  

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

Hi Sharon,

Questions you should be focusing on for today as well as for the near future, especially while she is ventilated and in the induced coma.

• Blood results, I.e. haemoglobin (red blood cells), white cell count (infection marker in the blood), LFT’s (liver results), Coagulation (INR, APTT), Coagulation is often going off the rails in liver failure and therefore there is an increased risk of bleeding
  
  

• Results of chest x-rays in order to assess her breathing function
  
  

• Ventilation settings and what is their plan to get her off the ventilator?
  
  

• What’s their plan to get her out of the induced coma and wake her up?
  
  

• Is she needing the inotropes/vasopressors for low blood pressure and how much is she needing?
  
  

• What are their plans for treating the liver failure? Have they progressed with putting your Mom on a liver transplant list?

You should be asking how much fluids they are taking off.

Related article:

• Why your critically ill loved one might need Dialysis (Kidney machine) or Hemofiltration for Kidney Failure (Renal Failure) and is having a Dialysis machine attached to them!

Those are probably enough questions for now.

Kind Regards

Patrik

Patrik,

I am doing a lot of reading and it says the odds for people with cirrhosis, that then causes MOF (Multi-organ failure) and low blood pressure and renal failure and over 60 is not good. I’m losing hope.

Sharon

Hi Sharon,

With the information that you have shared, I have not seen any evidence of this.

Again, do not get bogged down by their negativity and keep questioning and challenging them.

The next step for you is to ask for a meeting ASAP.

Kind Regards

Patrik

“Thank you very much for being a part of this series of 1:1 consulting and advocacy sessions. We hope you will find these new upcoming episodes informative and empowering.

Kind Regards

Patrik