Mom's in ICU for 6 weeks, Unable to Wean Off Ventilation & Tracheostomy After CABG, I Want Her Home

https://intensivecareathome.com/moms-in-icu-for-6-weeks-unable-to-wean-off-ventilation-tracheostomy-after-cabg-coronary-artery-bypass-graft-i-want-her-home/

Mom's in ICU for 6 weeks, Unable to Wean Off Ventilation & Tracheostomy After CABG, I Want Her Home

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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. 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 as well as 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 that also includes ventilator weaning at home.

Now today, I want to answer a question from one of our readers, Morgan, who says,

“Hi Patrik,

My mother is in ICU after an emergency CABG, CABG stands for Coronary Artery Bypass Graft, also known as open heart surgery, about 6 weeks ago. We have been told by the ICU that we should prepare for hospice because she is ventilator dependent with a tracheostomy.

Before all of this, she had no prior health problems other than breast cancer 15 years ago. She had chemotherapy and radiation. She also had complications during a cardiac catheter procedure which resulted in a coronary dissection, which is a rupture of a coronary artery and cardiogenic shock, which is the reason for the emergency coronary artery bypass grafts, also known as CABG or open heart surgery.

She had multiple complications postoperative including bleeding heart failure and 3 days of CRRT. CRRT stands for Continuous Renal Replacement Therapy. It is also known as dialysis or hemofiltration. Her kidney functions are close to normal now. She was on sedation for 14 out of 21 days in cardiac ICU before going to the general ICU.

On admission to the general ICU, we were told that she had severe sepsis and 2 small strokes that were discovered once the CT scan was done. She also had to get a tracheostomy during her stay in the cardiac ICU since she was unable to come off the ventilator before going to the general ICU.

Since the emergency coronary artery bypass graft, her ejection fraction is 40% but we are now being told she has metabolic encephalopathy since she’s not consistently responsive to commands and has been back on sedation for 14 of her 29 days in the general ICU.

She has also been failing her ventilation weaning program. I believe this has to do with the fact she has been back on sedation due to anxiety and becoming tachypneic. The settings are FiO2 of 30% and PEEP of 5.

We feel the ICU team are giving up on her too soon because she’s costing them too much time and resources. They are making me feel guilty as if I’m making her suffer but I think there is hope I want to give quality of life to her at home. How can we get her home? Thank you so much for all that you do.”

Thank you, Morgan, for sharing your email.

First off, thank you for detailing your mom’s situation and thank you for thinking ahead. You should give yourself a pat on your shoulder because you can see that in ICU, you can see that her needs are not getting met in ICU.

Continue reading at: https://intensivecareathome.com/moms-in-icu-for-6-weeks-unable-to-wean-off-ventilation-tracheostomy-after-cabg-coronary-artery-bypass-graft-i-want-her-home/