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 frequently asked question from our readers and the question in last week’s episode was
Can ECMO be a bridge to a heart transplant or a lung transplant?
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 continue answering the next 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 she has been subjected to dialysis due to kidney failure.
My mom may need to undergo a liver transplant. Can they take me as a live donor?
“You can also check out previous 1:1 consulting and advocacy sessions with me
and Sharon here.”
PART 1
PART 2
PART 3
PART 4
PART 5
PART 6
Patrik: Your welcome.
Sharon: It was definitely a good conversation.
Patrik: You’re most welcome. Take care.
Sharon: All right. Bye-bye.
Patrik: Bye-bye.
Patrik:
Speaking.
Sharon: Hi Patrik, this is Sharon. My dad spoke to the doctor, so I just wanted to ask you some questions.
Patrik: Yeah, sure.
Sharon: So in terms of the blood pressure they were able to bring down the medicine a little bit.
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Patrik: Great.
Sharon: But now they’re concerned. It’s like a different thing every day. They’re not even concerned with things, like about her breathing. Now it’s the blood thing you were saying.
Patrik: Mm-hmm (affirming). About the
blood pressure?
Sharon: Coagulation.
Patrik: Right,
right.
Sharon: But no, the coagulation. So they’re giving her blood to avoid clotting issues. That’s kind of all that’s changed at this point. So that’s their main concern now.
Patrik: Right. And do you know what she had in terms of blood products?
Sharon:
Blood pressure? No.
Patrik: No, no.
Sharon: I don’t know the exact number, no.
Patrik: So she had blood products because of the coagulation being off-
Sharon:
Right.
Patrik: Off range. And there’s a number of blood products that can be given. It could be red blood cells, it could also be platelets, or it could be fresh frozen plasma. Do you know what they’ve given?
Sharon: No I don’t know. I just know all my dad said was that they were concerned about clotting. So in order to avoid that, they’re
giving her blood. So that’s their new concern now, but the blood pressure seems to be stabilizing a bit.
Patrik: Right, right. And so if they’re concerned about the clotting, there’s a very good chance that they have given either platelets or fresh frozen plasma. Do you know, in the email that I sent you earlier, I asked about haemoglobin. Do you know what I’m referring to when I say haemoglobin?
Sharon: I mean, you wrote red blood cells, so I didn’t- My dad didn’t want to
answer, ask all those questions. I mean, I can ask them when I get to the hospital. I think they were kind of giving him the layman’s terms, you know?
Patrik: Most likely.
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Sharon: I do think her ventilation, they don’t seem to be- It’s just, this is like this roller coaster. Because literally two days ago, the thing they were most concerned about was her breathing. And now it’s like the thing they’re least concerned about. And then yesterday, the thing they were most concerned about was that having to get her low blood pressure up. And now they’ve been able to put the medicine down. So right now there’s this blood thing. And I know that they had
talked about the potential for that blood thing, and you had said so too, that that could be something that might come up.
Patrik: So have you-
Sharon: So is that fixable?
Patrik: It’s fixable in the short term, right? So with the coagulation going off,
right, as I said in the email, there’s a risk for bleeding, right? So if they are giving-
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Sharon: Right. And she hasn’t bled at all yet, they said.
Patrik: Right, right. That’s good, that’s good. If they are giving those blood products, and they are minimizing the risk of bleeding, she’s not- Have you asked in terms of, we talked about this yesterday and I mentioned it in the email, are they trying to work her up for a liver transplant? Is that a question that you’ve asked yet?
Sharon: I mean; I just don’t think she’s well enough yet. They’ve brought it to us when all of this is going on, to start getting her on
the list. But they haven’t- I think she’s too sick now for them to even-
Patrik: Consider?
Sharon: Do that. I mean, I’m assuming that’s what she’s ultimately going to need. But do they do emergency transplants?
Patrik: The first thing that she needs that in fact is
she needs to go on a transplant list, right? Once she’s on the transplant list, then they will look at emergencies, right? Then they will look at the priorities in terms of number one, is there a liver available? And then number two, how many patients are there who are recipients? And then it’s a matter of who needs it most.
Sharon: Right. And they wouldn’t do a live liver transplant if I
was……?
Patrik: You can ask, but it’s fairly unlikely. She needs to go on the transplant list first. And when people go on the transplant list, usually there is a transplant team.
And the transplant team will look at issues like they need to take blood, they need to establish the whole picture so that they can actually match a donor organ with your mother’s
blood.
Sharon: Right. Well I’m O-negative.
Patrik: Right. That would be one of the things they would be looking at, blood groups.
Sharon: Yeah. So, and my chances is O-positive.
Patrik: Right. You could take-
Sharon: So we’re both universal donors, so we could both be considered.
Patrik: Yes, but especially with the liver, or any organ really- Let’s say with any organ whether heart, kidneys, whether it’s lungs or the liver, the organs often come from somebody who’s
dying or has died within the last 24 hours. So it’s a very relatively complex process, because an organ needs to become available.
And as you would appreciate, they’re not becoming available every single day.
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Sharon: No, but I mean, aren’t there the live liver transplants where they could take a piece of the liver from somebody who’s living and give it to somebody?
Patrik: That would be new to me. It’s usually a whole organ they’re giving.
Sharon: Oh.
Because I’ve read so much about the live liver transplants, and how in some ways, they’re more successful. But now I don’t know.
Patrik: I think the next step really is she needs to go on a transplant list. That is the next step.
Sharon: Right. But can they control this blood thing? Like, what has to happen in her body for the blood to start
being normal again?
Patrik: So what has to happen is that her liver is normalizing, and it sounds to me like that’s not an option at the moment, given the situation she is in. And that is why they are giving the blood products. Because I mean, bleeding could be really detrimental to the whole situation.
Sharon: Right. So they’re just going to keep
giving her blood continuously? If she has to wait for a transplant, what do they do? Is there any process? So she’d have to go in for regular blood transfusions, in other words.
Patrik: Most likely. Do you know whether she had any blood transfusions in the last few days?
Sharon: No. This is the first time.
Patrik: This is the first time. Okay. So I guess, given that this is the first time, they will be looking at, okay, how effective is it, right? Like, is her coagulation responding to the blood transfusions? And then make an assessment from there.
I guess, given that we’re only at the beginning here, they will obviously assess in how effective is this.
Sharon: Right, okay. Okay, yeah. Because I mean, everything else, I don’t know what’s going on with the kidneys, but everything else- I mean, I guess it’s good news that her blood pressure is getting better, and that the ventilator is still not on a very high setting. So are those positive things at all?
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Patrik: They are positive things. But as I said in the email as well, I’m not really worried
about the blood pressure at this point in time, right? Any patient on the ventilator and in an induced coma is having the norepinephrine or the inotropes (vasopressors). It happens very, very often, and it doesn’t matter whether patients are in liver failure or they are in lung failure, or they have an infection, they often end up on the norepinephrine because the side effect of the medications is low blood pressure, right? So that’s a side effect of everything else
that’s happening, right?
So let’s just say for argument’s sake your mother was going to bleed. Her blood pressure would definitely go down, right? So they’re doing, by giving blood transfusions, they are doing everything they can to minimize the risk for the blood pressure to go down even further, right? On the other hand, what’s important there to look for as well, so now she’s getting blood transfusions. With the kidneys not working, her
volume in the blood will go up and then there is the risk, with the kidneys not working, that fluid push back into the lungs, right? So then they need to start the hemofiltration (Haemodialysis), so that she’s not getting fluid overloaded in the lungs. Because that, then, could become detrimental to the breathing.
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Sharon: I think they’ve already started doing that. That was the thing they started doing
yesterday.
Patrik: Good.
Sharon: That’s the tube they put in to push the fluid out of the lungs.
Patrik: Yep. That is good.
Sharon: So what do they have to get under control, then, for her to have a
chance at this point?
Patrik: They definitely have to get the coagulation under control, right? They have to get the fluid balance under control, and your mom- And by fluid balance under control, I mean what they’re putting in needs to come out, and the kidneys are not in the position at the moment to regulate that by themselves. So that’s why she’s on the hemofiltration, right? And have they mentioned, do they want to take her off the ventilator in the next few days? Have they discussed that?
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Sharon: They haven’t mentioned that. I mean, I think the hope is to always be able to wean you off of it at some point, but they haven’t mentioned that. They haven’t mentioned it now. I think they moved it up to 50, just when they did the procedure, but she was only at 40. So I don’t know. I mean, I don’t know. I don’t
know.
Patrik: Yeah, sure. Look, what do they need to get under control? Obviously the most important thing is the liver. As long as the liver is failing, it sounds like
the kidneys are failing, right? So can they control the liver with medications?
Probably not, cause there’s very little that can be done for liver failure in terms of
medication management. It’s often a matter of giving the liver a rest, right? So that the liver can recover, right. You can certainly ask if they are medically managing the liver failure. Hence, are they giving any medications?
Sharon: They’re giving the lactulose, and stuff like that.
“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
