My Dad’s in ICU Ventilated with COPD & Emphysema! Is Having a Tracheostomy and Going Home an Option?

https://intensivecareathome.com/my-dads-in-icu-ventilated-with-copd-chronic-obstructive-pulmonary-disease-emphysema-is-having-a-tracheostomy-and-going-home-an-option/

My Dad’s in ICU Ventilated with COPD & Emphysema! Is Having a Tracheostomy and Going Home an Option?

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Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies and where we also provide tailor-made solutions for hospitals and intensive care units whilst providing quality services for long-term ventilated adults and children with tracheostomies, and also otherwise medically complex adults and children at home, including Home BIPAP (bilevel positive airway pressure), Home CPAP (continuous positive airway pressure), home tracheostomy care when adults and children are not ventilated, also Home TPN (total parenteral nutrition). We also provide IV potassium, IV magnesium infusions at home, and IV antibiotic infusions at home. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as palliative care services at home, and sometimes even ventilator weaning at home.

We also send our critical care nurses into the home to avoid emergency department admissions (ED admissions). So, we’re also providing an ED bypass service into people’s homes, as well as into residential aged care or any other facilities where you would like our service.

Now, I want to answer a question today that I had from Kat. Let me read that Kat’s email and answer a question, she says:

“Hi Patrik,

My dad was admitted to ICU and intubated 10 days ago for influenza A with COPD and emphysema. We were told they would wean him off sedation on Day 4, but then we were told he wasn’t ready. The ICU doctor says he is about 20% of lung function. They are now saying that a tracheostomy is the next step but have not tried to wean him off sedation or ventilation.

Being trapped in an ICU on the ventilator to die is his biggest fear as he saw both of his parents pass away in ICU. I am looking for options to get him a better quality of life. If he cannot come off the ventilator, I want to be his strongest advocate in receiving the care and treatment he needs, both medically and mentally.

Can you help? From Kat.”

Well, thank you, Kat, for writing in and for asking such a detailed question.

Now first off, if his lung function is at 20% capacity, that’s really low. The question is why? I mean, he’s got a history of influenza A, COPD, emphysema, is there something else going on? Does he have pneumonia? Does he have ARDS (Acute Respiratory Distress Syndrome)? Do they think there is a way forward to improve his lung function? Does he need to go on ECMO (Extracorporeal membrane oxygenation) to improve his lung function? Does he need nitric oxide? Epoprostenol? Any other nebulizers that might help him to improve his lung function? It’s all depending on his condition.

Tracheostomy might be the next step here if he can’t be woken up, and if he can’t be weaned off sedation. Also, keep in mind, it would be difficult to wean him off sedation if he’s at 20% of lung function. So, here’s the deal, if he had 20% of lung function and they take off sedation and he can’t breathe, with no lung function, it’ll only distress him. Therefore, keeping him sedated and working towards the tracheostomy might be the better way to go here...

Continue reading at: https://intensivecareathome.com/my-dads-in-icu-ventilated-with-copd-chronic-obstructive-pulmonary-disease-emphysema-is-having-a-tracheostomy-and-going-home-an-option/