CAN MY SON GO HOME FROM ICU On BIPAP VENTILATION&TRACHEOSTOMY? HE HAS ALS& HE’S A CO2 RETAINER

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CAN MY SON GO HOME FROM ICU WITH BIPAP VENTILATION AND TRACHEOSTOMY? HE HAS ALS AND HE’S A CO2 RETAINER, HELP!

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In today’s video blog, I want to answer another question from one of our readers, Ellen and Ellen sends an email and Ellen is in Melbourne, Australia.

Ellen asks

Can my son go home from ICU with BIPAP ventilation and tracheostomy? He has ALS and he’s a CO2 retainer, help!

Hi Patrik,

My son has a tracheostomy and is in ICU. He does well without ventilation support for 12 hours with carbon dioxide or CO2 in the range of 37 to 47.

My question is, can he be managed with BiPAP at home over night? My son is 36 and he has a history of retaining carbon dioxide, which has improved over time. My son was diagnosed with ALS about eight months ago. He walks with assistance with a cane and he has been in the hospital now for two months.

He went with low sodium, elevated CO2 up to 57 and elevated blood pressure. He was unmonitored for awhile and passed out, and he had to be intubated on three different occasions before he went into ICU long-term. Hence with the ventilation, he also got hospital acquired pneumonia with klebsiella and pseudomonas.

He got over it in the end. He had a tracheostomy about two months ago, and he’s doing well without a ventilator now for over 12 hours. The ICU feels he may need to stay in ICU for quite some time until he’s completely weaned off the machine. I, on the other hand, believe that home ventilation and intensive care at home is appropriate with BiPAP instead.

Please advise what your options are.

Ellen

Hi Ellen,

Thank you, Ellen, for sending this email and clarifying your son’s situation. It’s what the ICU is telling you is very old fashioned and it’s sort of, they’re stuck in what they’ve been doing for decades and it’s clearly not working. Of course, your son can go home and should go home with intensive care at home nursing rather than staying in ICU for the next few months until he supposedly comes off the ventilator.

Now with ALS, I think there’s a high chance your son may need ventilation for quite some time to come as it’s usually a progressive disease.

Can BiPAP be done at home overnight? Absolutely, yes. We could also monitor his CO2 either with a monitor or even with blood gases that we could take from the ear.

So there’s a number of ways to manage your son at home safely, either with just overnight nursing care, but I believe your son will need 24 hour nursing care because if he’s stuck in ICU 24 hours a day, he will need ICU and intensive care at home 24 hours a day and we can provide that for you.

So, the BiPAP will most likely get his CO2 down because that’s what BiPAP usually does. And now that it’s 37 to 47. It’s not too bad, but you know, usually below 38 is better consistently.

So here is where our model of care fits in really in this with the ICU as well. You know, your son can’t go to a hospital ward because the hospital wards can’t look after ventilation and tracheostomy.

Can my son go home from ICU with BIPAP ventilation and tracheostomy? He has ALS and he’s a CO2 retainer, help!

So the only really option for your son to be weaned off the ventilator safely instead of an ICU is at home. We’re sending ICU nurses into the home 24 hours a day. So we’re basically providing an intensive care substitution service that has a lot of advantages for the hospital and the ICU as well...

Continue reading at: https://intensivecareathome.com/can-my-son-go-home-from-icu-with-bipap-ventilation-and-tracheostomy-he-has-als-and-hes-a-co2-retainer-help/