I Want Information for my Husband Who Has Been in ICU for 6 Weeks, on a Ventilator. Can He Go Home?

https://intensivecareathome.com/i-want-information-from-my-husband-who-has-been-in-icu-for-six-weeks-on-a-downward-cycle-and-on-a-ventilator-can-he-go-home/

I Want Information for my Husband Who Has Been in ICU for Six Weeks, on a Downward Cycle and on a Ventilator. Can He Go Home?

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In today’s blog, I answer another question from one of our readers and potential clients. Katie is writing in and she says,

I Want Information from my Husband Who Has Been in ICU for Six Weeks, on a Downward Cycle and on a Ventilator. Can He Go Home?

So I read out Katie’s question here. Katie writes,

Hi Patrik,

I am gathering information for my husband who has been in intensive care now for six weeks with a cycle that continues and doctors and nurses who are very nice, but unable to get to the bottom of things or get the right dosages of medications.

As I said, he has been in ICU for six weeks with a cycle of going on with low blood pressure and poor kidney perfusion, complicated by atrial fibrillation and high heart rate. We are looking to bring him home, but need a knowledgeable nursing team.

Before he’s going home, we know he needs a tracheostomy and at the moment he is still on a breathing tube and a ventilator. He doesn’t have a tracheostomy yet because he’s also got COVID-19 and the ICU team is reluctant to do a tracheostomy just simply because of the risk for the staff and also because he’s got high PEEP, high oxygen requirements up to 80%, and simply he hasn’t been well enough to do a tracheostomy.

What should we do? Can we get my husband home?

From Katie

I Want Information from my Husband Who Has Been in ICU for Six Weeks, on a Downward Cycle and on a Ventilator. Can He Go Home?

Hi Katie,

Thank you for writing in and thank you for sharing your husband’s situation. It sounds to me like your husband is a while away from going home. The next thing that needs to happen is he needs to have a tracheostomy first. Once he has a tracheostomy, then he needs to come off all the medications that he’s on.

You are describing in right dosages of medications, you’re probably referring to sedation and opiates. As soon as he has a tracheostomy, the intensive care team should be able to reduce sedation and opiates, and then hopefully slowly wean him off the ventilator.

But if he’s on 80% of oxygen and a PEEP of 12, it could be very difficult for them to do a tracheostomy. He’s not stable enough. And also currently with COVID the risk of staff getting infected when a tracheostomy is done is fairly high.

The other thing you mentioned is he’s currently in the ICU with a cycle going on with low blood pressure and poor kidney perfusion, complicated by atrial fibrillation and high heart rate. So again, Katie, that needs to be brought under control first. He needs to get off the inotropes/vasopressors for low blood pressure and the atrial fibrillation needs to be brought under control as well.

Often how that happens in ICU is with medication such as Amiodarone, Digoxin, especially for fast AF, as well as potentially a cardioversion, which is an electrical shock. Once that’s under control, once he’s off sedation, once he’s off opiates, once he’s off the inotropes and vasopressors, once the atrial fibrillation is under control only then can you look at options such as intensive care at home.

So it’s probably a little bit too early for you in that cycle. What you might want to do as a next step, Katie is have a look at our sister website, intensivecarehotline.com where we also provide consulting and advocacy for families in intensive care.

Because at the moment I feel like it’s a difficult situation for you and your family, because you are unsure about what the next steps are and a lot of that we talk about at our sister site intensivecarehotline.com...

Continue reading at: https://intensivecareathome.com/i-want-information-from-my-husband-who-has-been-in-icu-for-six-weeks-on-a-downward-cycle-and-on-a-ventilator-can-he-go-home/