Hi, it’s Patrik Hutzel from intensivecarehotline.com , where we instantly improve the lives of Families of critically ill Patients in Intensive Care, so that you can 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 last
week was Part 5 of
MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE
CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO? (PART5)
You can check out the answer to 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 question from Heather, as part of her consulting sessions with me.
Previous questions(Part 1, Part 2, Part 3, Part4 and Part5) from Heather you can find answered by clicking on the relevant links.
Today, Heather asks
MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE
INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO? (PART6)
Hi Patrik,
A few more issues have come up since we last spoke and they have now found that
- my partner has liver cirrhosis. This is the first I've heard of it when I visited my partner yesterday. They are giving him albumin and they have taken him off of the Lasix(Frusemide). They have done this before. Why
does the swelling keep happening? They did a CT of his abdomen and he had fluid polling up there and he is leaking where his chest tube was.
- When he was first admitted to the ICU at the first hospital they wanted consent for a PICC line and that kidney doctor wouldn't ok it so they went with the main line. The kidney issues were under control so the kidney doctor signed off the case. I was just wondering if the PICC line put some strain on the kidneys maybe? He is off of the Propofol and still on Fentanyl. He had hallucinations causing agitation that was due to pain I think. They gave him Delaudid(Hydromorphine) and now he is sleeping.
He's still having the muscle spasms I think are because of the Quetiapine. I don't know for sure though. They are also giving him Depakene. Is this stuff something that everyone who gets intubated gets or just
him?
If it is for agitation or hallucinations it isn't working.
I have read about several adverse reactions. Do you think if I asked them to stop giving them to him that it would make things worse?
I know these meds are for treatments of bipolar and schizophrenia and I don't have a bias against that. I have had experience with mental
illness and I know that it's very much trial and error as to which meds are working and at what doses.
I don't think with all of the other stuff going on we can accurately treat any of that, but I also don't know if his mental state because of the other stuff could be worse without it.
I feel like my partner with no mood stabilizers and anti psychotic meds would be able to cope with
things. I don't know if you understand what I'm saying. Do you think it would hurt things if I asked them to stop those meds right now?
I also read something about those and the Nafcillin contributed to liver malfunction I have to do more research there. The nurse did say he had ICU delirium and Quetiapine is being used to treat psychosis.
I just want to know what you think because it could be I'm just picking on the Quetiapine. I did read
something about it and liver. He just woke up and he is clearly hallucinating and mouthing help and sticking his tongue out. He starts breathing the machine and is now breathing more by himself.
It would be good if we can speak on Skype again so that you can explain to me what’s going on!
Many thanks
Heather
Hi Heather,
let's look at the easy things first.
- No, there is no issue with PICC lines causing kidney disease whatsoever.
Given that your partner has liver cirrhosis, it
would be good if you also told me whether the cirrhosis has been alcohol/ drug induced or whether it has been induced by acquiring Hepatitis inadvertently.
In any case, you've got to look at the bigger picture here.
And the bigger picture is that your partner has been in Intensive Care now for a couple of months with a tracheostomy after a couple of failed weaning attempts off the ventilator.
His liver failed with cirrhosis and the challenge here is that numerous medications he is getting may not metabolise- or in other words don’t work- because of the liver not being able to process the drugs.
I therefore won't be getting too caught up in what medications he's getting or not getting and whether they are working
or not working because of the inability of the liver to metabolise most of the drugs.
The main questions and issues you and your partner are dealing with are
And yes, swelling is a side effect of the liver failure/ hepatitis and therefore he needs Albumin to reduce the swelling. A failed liver stops Albumin production and with low Albumin people get swollen or oedematous.
All the medications your partner are getting is to keep him calm and pain free.
It’s particularly
challenging because your partner is blind and he would be more agitated than other critically ill Patients in a similar situation!
Quetiapine normally works really well from my experience to calm Patients down when they are on a ventilator and delirious!
But all the medications he is getting, whether the Quetiapine, the Hydromorphine and the Fentanyl are there to calm him down and they
probably work to a degree despite the liver failure.
The problem is that your partner has been in Intensive Care for too long now as he has reached the two
month mark.
ICU psychosis or ICU
delirium is a real issue and as I mentioned before, your partner not being able to see doesn’t help his case.
What needs to happen here is to wean the medications he is on off slowly over many days and he also needs to continue with Physiotherapy.
Physiotherapy and stimulation are so important that your partner can get back to normality! Drugs and medications can only ever be a
short term aide, but never a long-term strategy!
Normally I would say that especially after two months in ICU, your partner should be moved into a room where he can have natural daylight, as most Intensive Care Units don’t get much natural daylight!
However with your partner’s inability to see, it may well not be so important, but it’s something you may want to keep in
mind!
Furthermore, the nurses should be looking at getting your partner to have regular showers. This often works wonders too and can just be as good- if not better- as medicine, to get your partner out of the delirium and less agitated.
Unfortunately, all too often critically ill Patients in Intensive Care, especially long-term Patients in Intensive Care end up being delirious and agitated and it’s a big issue.
They may physically improve, however they are still in “la-la-land” so
to speak and getting them out of that state is critical.
As I said before, drugs can only be an aid and not the cure. Stimulation, Physiotherapy, patience as well as good nursing care are often the answer.
You should also check out this article here for more information about delirium in Intensive Care
Related
article:
You also mentioned Depakene and it’s unclear to me why he’s getting it. It’s normally given to prevent seizures, however you never mentioned anything about seizures. Maybe you can clarify if your partner had any seizures in the past or if he’s at risk of having seizures.
We also have a great resource(Ebook, Videos and audio recordings) available that’ll help you to steer the ship while your partner remains a long-term Patient in Intensive Care and is at risk for “treatment limitations” and
“withdrawal of treatment”
FOLLOW THIS PROVEN 6 STEP PROCESS, ON HOW TO BE POWERFUL, IN CONTROL, INFLUENTIAL AND HAVE PEACE OF MIND, IF YOUR LOVED ONE IS A LONG-TERM PATIENT IN INTENSIVE CARE OR IS FACING TREATMENT LIMITATIONS IN INTENSIVE CARE!
I know Heather it’s easier said than done, but you need to be patient. Being critically ill in Intensive Care often means two steps forward and one step back. I know this situation is tiring,
exhausting and extremely stressful for you, but you need to stay strong for your and your partner’s sake!
Your partner still has a long way to go and he needs to get out of the delirium first so that he can comply with the instructions, as well as the Physiotherapy in order to be weaned off the ventilator and the tracheostomy!
We’ll go on Skype again and talk about things in more
detail!
Take care!
Patrik
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Patrik Hutzel
Critical Care Nurse
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