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 our readers and the question was
ICU vs Intensive Care at Home vs LTAC?
You can check out last week’s question by clicking on the link here.
And in today’s episode of “YOUR QUESTIONS ANSWERED” I want to answer a question from one of my clients, Alicia and Alicia has her 72-year old husband in intensive care for three months now and Alicia wants to know if her husband can go home even on a ventilator with tracheostomy and on dialysis.
“My Husband is in ICU for 3 months on a Ventilator with Tracheostomy and on Dialysis. He Can’t Be Weaned Off the Ventilator. Can He Go Home?
So Alicia writes. My husband’s 72 years of age, had a right tibial artery blockage with loss of blood flow to his great toe and atherectomy by a vascular surgeon was done and a nephrotoxic contrast media caused worsening of kidney dysfunction to stage 5, but gradually improved somewhat next
hospital day.
My husband had a heart attack or an MI and intermittent atrial fibrillation for the first time. Prior to that, he had history of mild congestive heart
failure.
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He was readmitted for a right great toe amputation then he went back home again. After that his kidney function deteriorated and his third admission was on the 7th of July for uremia with mental confusion and he was started on emergency dialysis.
About 10 days later, he developed first hospital acquired pneumonia. It was slow to respond to antibiotics after that there was an acute and rapid drop in oxygen levels and he was finally put on a ventilator.
The infectious disease specialist thought that probably it was secondary to a large mucus block. My husband couldn’t come off the ventilator for the next two weeks and a tracheostomy and PEG tube was done on the 24th of August during the course of his intensive care stay.
He developed a sacral pressure ulcer during his stay, which progressed markedly and after debridement and removal of large amount of adjacent tissue, it’s now a stage 3 pressure sore and wound treated by wound care team and has been on a rotating bed.
Now the intensive care team then wanted to transfer him to a long-term acute care hospital, which I refused. Because I know that he is so much better off in an intensive care unit, especially with his ventilation and tracheostomy needs.
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A couple of weeks later, he developed a second hospital acquired pneumonia this time. It was MRSA, he improved clinically with antibiotics and his white cell count decrease from 28,000 to 18,000, but has never returned to normal. His white cell count on the 30th of August was around 14,500. Now just for everybody that doesn’t know what white cell count stands for, it basically is a marker in the blood for infections. Normal white cell count is four to
11,000 and anything above 4,000 above 11,000 really is a sign of an infection, right?
Chest x ray has shown bilateral pleural effusions was on the right, but also residual infiltrate in the right lung last week. He’s had some chest
drains for that to drain the pleural effusions presently he’s having hemodialysis three times a week with additional treatments added for fluid removal as needed the lengthy ICU stay multiple complications and lack of adequate nutrition have resulted in extreme weakness.
My husband remains primarily bedridden except for being up in a chair for two hour sessions two times per day. He has continued to have paroxysmal AF atrial fibrillation more frequent when he’s extremely tired or stressed.
Yes. In terms of ventilation weaning, my husband had worked up to 24 hours off two times, but then had to start over again because of the pneumonia and the extreme fatigue.
He has been on the tracheostomy collar for three 16-hour sessions and one 20-hour session this past week overall, it has been a difficult and delicate balance between adequate fluid removal and the extreme fatigue associated with dialysis causing increased dyspnea.
My husband had done well with trials of applesauce and diced peaches, and we’ll have a swallowing study done next week to further evaluate the possibility of feeding by mouth again.
So the current is to transfer him to a skilled nursing facility with the pulmonary unit that can take care of a tracheostomy and ventilator patients, and also do in-house dialysis.
I am an advocate of holistic healthcare and would much prefer to have him at home instead and have the ability to add appropriate supplements to his treatment regime, to strengthen his body and immune system.
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In the meantime, my client, Alicia writes further because that’s a while back and now her husband is in a long-term acute care facility and now she writes. The LTAC has been as aggressive as they could be with weaning. The problem for him is his extreme weakness, balancing removal of fluid and dialysis, which are exhausting and avoiding atrial fibrillation, which occurs when he’s stressed, pulmonary cardiac and anxiety.
He is now on his third attempt. He had worked up to be being off the ventilate at least one 24-hour period, two different times and then he had to go back on the ventilator because of the second hospital acquired pneumonia and the arrhythmia issues with atrial fibrillation.
This time he has done three consecutive 16 hours off and the 20 hours off, but just found out yesterday that he’s being cut back again to 12 hours.
And I am not happy because I don’t think the hospital is trying hard enough to get my husband off the ventilator. What do you think I should be doing next?
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The 1:1 consulting session will continue in next week’s episode.
Kind regards,
Patrik
