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Hi it’s Patrik Hutzel from INTENSIVE CARE AT HOME where we provide tailor made solutions for long-term ventilated Adults & 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 patients and medically complex patients at home, including home TPN.
In last week’s blog, I talked about,
HOW LONG WILL MY SON BE SEDATED AFTER THE TRACHEOSTOMY?
You can check out last week’s blog by clicking on the link below this video:
In today’s blog post, I want to answer a question from one of our clients and the question today is
Mom’s Been in ICU for 3 Months, What are the Long-Term Effects of Mechanical Ventilation?
Good morning, good afternoon, good evening wherever you are. Welcome to another livestream for Intensive Care At Home and Intensive Care Hotline.
Today’s topic is, “My mom’s been in ICU for three months on a ventilator with a tracheostomy after COVID pneumonia and COVID ARDS, what are the long-term consequences of mechanical ventilation?”
It’s a very timely and very hot topic at the moment in the intensive care community. It has always been a hot topic in the intensive care community and for patients and for families, of course. But COVID has increased the number of patients in intensive care that needed prolonged mechanical ventilation. And prolonged mechanical ventilation is actually defined as anyone needing mechanical ventilation for more than 21 days.
And that’s only 5% of the patients that actually go in intensive care. Various studies show that. Now, those studies are predominantly from before COVID. So I would assume that the number of patients in intensive care that require prolonged mechanical ventilation has gone up. And I’m sure the studies will come out reasonably soon about that. So before we dive deeper into today’s topic, just a few things you might wonder what makes me qualify to talk about today’s topic.
My name is Patrik Hutzel, founder and editor of Intensive Care Hotline, and also founder and director of Intensive Care At Home. I have worked in intensive care for over 20 years as a critical care nurse in three different countries and out of those, over 20 years in intensive care, I’ve worked as a nurse unit manager in intensive care for over five years.
I have been consulting and advocating for families in intensive care all over the world as part of my Intensive Care Hotline consulting and advocacy service since 2013. And I have been running Intensive Care At Home since 2012. So we are looking after long-term mechanically ventilated patients outside of intensive care as a genuine alternative to intensive care.
So I believe I have lots to say today about what are the long-term consequences of mechanical ventilation, and also what are options for someone that is mechanically ventilated in intensive care for over 21 days. What are the options for them? Is it just doom and gloom? Or are there options outside of intensive care? What are the options inside of intensive care? And I will make that part of today’s discussion.
Now, if you have questions, you can type them in the chat pad. Please keep them to today’s topic if you can. And you can also call into the show after we’ve gone through today’s presentation. But if you have any questions, please just type them into the chat pad and I will answer your questions as we go along. So again, today’s topic is, “Mom’s been in ICU for three months with ventilation and tracheostomy after COVID pneumonia and COVID ARDS, what are the long-term consequences of mechanical ventilation?”
Now, first off, when you look at intensive care studies about prolonged mechanical ventilation, they pretty much tie in with all the doom and gloom that you hear from intensive care teams. And I think it’s really important to have perspective around the doom and gloom and the negativity in intensive care. Because intensive care teams often don’t look outside of intensive care. They’re the specialists what’s happening in intensive care, but they’re not the specialists at predicting long-term outcomes.
Now, the first thing you need to know is that around 90% of intensive care patients do survive, and that has not changed with COVID, as far as my research has shown. So that means the odds are in a patient’s favor.
So with the odds being in a patient’s favor, leaving intensive care alive, of course, the questions need to be raised: what does survival mean for patients? Is it meaningful survival? What does quality of life look like? What are options for people coming out of intensive care, whether with or without mechanical ventilation?
One of the major challenges in intensive care has always been that mechanical ventilation has not been perceived as doable outside of intensive care, with some rare exceptions of patients in the United States going to long-term acute care facilities or LTACs, but that’s probably the rare exception. Up until 10, 20 years ago, there has been no perceived alternative for long-term mechanically ventilated patients, adults and children to leave intensive care safely.
The only place for those people to stay was intensive care. And of course, with intensive care resources being scarce and being in short supply. Often, intensive care teams, and still to this day, suggest that the only option and the best option is to stop treatment. Because this person on a ventilator, depending on ventilation with a tracheostomy, won’t have any quality of life.
Well, I say, won’t have any perceived quality of life. That’s the intensive care team’s perception without actually knowing what we, for example, do with Intensive Care At Home. But I’ll come to that later. Let’s just look at, what are the consequences of long-term mechanical ventilation?
Again, starting from the definition. The definition is that prolonged mechanical ventilation starts at day 21 in ICU. Around 83% of patients that receive prolonged mechanical ventilation greater than 21 days in a row also end up with a tracheostomy. Makes sense to me, the cut-off. To have a tracheostomy is around the day 10 to day 14 mark after having a breathing tube or an endotracheal tube.
So what are the consequences from a hospital point of view or from a health care point of view, health service point of view? So the first is that, apparently there’s a high hospital mortality rate. Of course, patients that are on ventilation are at higher risk of passing away. There’s no question about that.
At the end of the day, they are on life support. Mechanical ventilation is considered life support. And whilst they are in intensive care in the acute phase, there’s a very high chance they have multiple other life-threatening things going on, mechanical ventilation, just being one of them. Whether they’re in ICU after surgery, they’re in ICU for ECMO, they’re in ICU for cancer treatment, they’re in ICU after a motor vehicle accident. The list is endless. The list goes on. And of course, there’s a higher risk for mortality.
There’s also higher risk of healthcare utilization. Of course, there is. The intensive care bed in a hospital is the most expensive bed in a hospital, the most resourced bed in a hospital, of course. And even if people go home with our service, Intensive Care At Home, after a prolonged stay in ICU, even the cost in the community is probably at the higher end. But the cost in the communities is a lot less compared to the cost of an intensive care bed in a hospital. An intensive care bed in the hospital, at the moment, we’re talking about $6,000 per bed day.
Doesn’t matter whether it’s in the US, it’s around 6,000 US dollars per bed day. In Australia, it’s around 6,000 US dollars per bed day. In the UK, at the moment, you’d probably be looking at 4,000 British pounds per bed day. The price for healthcare has increased exponentially in the last few years, especially with COVID running rampant in the community and then in hospitals.
Next, there is also a higher post-discharge mortality, meaning that if patients have prolonged mechanical ventilation and they do go home, there’s a higher post-discharge mortality. And of course, anybody that’s been in ICU for prolonged periods is at higher risk of dying, they have more comorbidities. But what the studies are not telling you, I’ll tell you what the studies are leaving out conveniently.
For example, when patients go home with our service, Intensive Care At Home, even though they’re on mechanical ventilation with tracheostomy, their life actually, most of the time, is prolonged. And that is out of choice. That’s out of choice for the patient, for the families, what they want. And 20 years ago, 25 years ago, there was no alternative for them in the community. But now there is. And therefore, the mortality automatically is reduced.
But the studies are not looking outside of intensive care in terms of when it comes to Intensive Care At Home. It leaves out a very important component in the community. We talked about healthcare cost, that a prolonged intensive care stay is very expensive. We talked about that prolonged mechanical ventilation is considered for anyone being ventilated for over 21 days. You can do the maths. Let’s just say 30 days x $6,000 per bed day, you’d already be looking at $180,000 for a 30-day stay in intensive care.
But I really don’t want to focus on the finances today because I believe life is precious. And you can’t measure the value of a life in monetary terms. And I just want to leave it there. Now, other consequences of prolonged mechanical ventilation are a decrease in functional capacity. And that ties right in with the deconditioning, the muscle wastage, which apparently starts right after 18 hours of mechanical ventilation, which also means 18 hours of induced-coma and sedation.
So the muscle wastage and the deconditioning starts very, very quickly right from the start. Then there is a mental toll for patients and for families, of course. A prolonged stay in ICU, once patients wake up, they can be confused, they can be agitated, they can be delirious, they can even be aggressive because of the side effects of the induced coma, the side effects of all the medications they’re getting while they’re in an induced coma, which could also lead to ICU psychosis, ICU delirium, which just adds onto the already long list of medical conditions someone has while they are in ICU.
Now, again, some studies also suggest that when patients leave intensive care alive, that they have a poor quality of life. And I suggest here that the statement of poor quality of life is an incomplete statement. It needs to say, “perceived quality-of-life.” The person who’s making that claim, or the people that are making the claim, that people don’t have any quality of life outside of ICU, need to say that’s their perception. Ask the people, ask the families, ask the patients what they want, what are they happy with, what are they happy to put up with?
Do they want to die? Ask them. You’re not asking the questions. We’ve been in so many family meetings in intensive care, it’s part of what we do that patients and families are not even asked; they’re just being almost reprimanded to say, “Well, your loved one won’t have any quality of life anyway.” Well, how would you know?
ICUs are very poor predictors of what’s happening outside of ICU. And they don’t know the details what’s happening in the community. Like we know with Intensive Care At Home, we have so many insights. And not for one minute, would families give up the life for their loved one. Not for one minute, would people that are under our care, would not want to live.
And there’s plenty of case studies on our website at intensivecareathome.com, where you can read about what people’s lives look like. If it was up to the ICU, they would be “pulling the plug” and let people die. Well, there’s definitely no quality of life then, once people are dead. And you need to factor in what’s the mental toll for patients and for families if someone dies. What’s the mental toll of that? It’s huge.
There’s a mental toll either way. There’s no question about that. I’m not denying that for a minute. But you got to deal with the issues at hand and you got to do what’s best for a patient and you got to do what a patient and the family wants.
Now, let’s move along. What other side effects are there for prolonged mechanical ventilation? Mucosal alteration, due to decreased gastric blood flow. No question about that. Especially, when someone is on prolonged mechanical ventilation, they have high pressures going into their lungs, which then puts pressure on the digestive system. And there’s decreased blood flow in the gut, which could lead to ulcers, could lead to GI bleeds.
There’s no question about that. I’m not denying that for a minute. And that is definitely an undesired side effect of that. Then there is an aspiration risk. Aspiration means that gastric content can be aspirated into the lungs, even though a breathing tube or a tracheostomy has a cuff or a balloon, that should stop aspiration. But there’s still a risk that even a balloon or the block is not stopping people from aspirating.
I would argue that many patients in intensive care, but also at home that are ventilated and are on nasogastric tube feeds or PEG (Percutaneous Endoscopic Gastrostomy) tube feeds, are at higher risk of aspiration because their digestive system is slower than the average person.
Especially, also with sedatives, with patients having sedatives and opiates. That’s all slowing down the digestive system and therefore, there’s a higher risk for aspiration. Also, patients lying flat, patients getting turned. Imagine you’ve got a full stomach and you’re lying flat, or you’re getting turned. There’s a higher risk for vomiting and so forth.
Next, sleep disturbance. As I mentioned before, people are sleep disturbed in intensive care. There’s a disturbed day and night rhythm. Lights are on in the ICU 24 hours a day, people are talking in ICU 24 hours a day. Most ICUs can be noisy overnight because it’s busy or it can be busy. And imagine you can go home with Intensive Care At Home instead, how much nicer that is to be in your own home where it’s quiet, where you can determine the routine, where you can manage a routine in combination with our team, with our staff. How much nicer is that?
Next, Neuropsychiatric complications. Again, as I mentioned before, patients coming out of prolonged intensive care stay can often be depressed, they can have anxiety, they can be aggressive, confused, can have ICU delirium, and ICU psychosis. Again, I’m not suggesting here that being a long-term intensive care patient doesn’t have undesired side effects by no means. That is absolutely accurate that it has undesired side effects. No question about that. But that doesn’t mean that treatment should be stopped like many ICU teams suggest.
Next, VAP, also known as, ventilator-associated pneumonia. Anybody that is on a ventilator for prolonged periods of time is at risk of a ventilator-associated pneumonia. Why is that? If people stay in hospitals for long periods of time, they are prone for ventilator-associated pneumonias or any other infection for that matter because a hospital environment just is high-risk environment to contract an infection.
Whereas, in a home care environment, the risk for a ventilator-associated pneumonia is reduced, assuming you have Intensive Care At Home services with 24 hours Intensive Care At Home nurses who know how to manage a ventilator, who know how to manage a tracheostomy, who know how to prevent patients and families from ventilator-associated pneumonias.
Next, ventilator-associated lung injuries. Again, that is an undesired risk when someone is on prolonged mechanical ventilation. For example, a ventilator-associated lung injury is barotrauma or a pneumothorax. Again, if someone is on a ventilator, positive pressure is going into the lungs, which simply puts someone at risk to sustain a barotrauma or a pneumothorax, which then would need a chest drain insertion as treatment.
Next, I briefly spoke about muscle wasting and deconditioning. Again, that is definitely happening in ICU. It’s almost, for any long-term patient, they need to start to learn using their arms and legs again, they need to start walking again, which can take a long time. People may never fully recover from an ICU state. There’s no question about that, that this is definitely a side effect of prolonged mechanical ventilation.
And unfortunately, a lot of our clients in the community have a disability because of their prolonged ICUs. They are dependent on full nursing care or they’re dependent to have other people do their ADLs, their activities of daily living. So yes, they are fully dependent on other people. But again, what’s the alternative?
And it’s actually a vicious cycle when people go into ICU, go into an induced coma, end up with prolonged mechanical ventilation and they get deconditioned. It’s a vicious cycle that’s been set off there. What the vicious cycle means is, you’re starting to decondition pretty quickly. And when you’re starting to decondition, it’s getting harder for you to be weaned off a ventilator.
So that’s why it’s a vicious cycle. The quicker you can be weaned off the ventilator if you end up in ICU on a ventilator, the better it is. The quicker you can be weaned off a ventilator, the better because then you can get out of ICU quicker, you don’t need a tracheostomy. You need to break out of that vicious cycle as quickly as possible. Because if you can’t break out of that cycle, it leads to weaning challenges.
And for anybody that’s in ICU for over 21 days, and can’t be weaned off a ventilator, it’s often a side effect of their condition, but it’s also often the deconditioning aspect of the mechanical ventilation.
Next, another undesired consequence of long-term mechanical ventilation is swallowing issues. So in the early days of mechanical ventilation, someone has a breathing tube in their throat. And then with long-term mechanically ventilated patients, many patients end up with a tracheostomy, which also inhibits patients to have a good swallow.
And if patients come to the point where they can have the tracheostomy removed, or even the breathing tube removed, swallowing may need to be relearned. And that is also where there’s aspiration risk. And usually, swallowing being relearned is the task of a speech pathologist. They’re the experts at that.
Also, there could be a tracheal stenosis as a side effect, tracheomalacia, and weakness of the trachea. There could be a fistula developing between the trachea and the esophagus. So they are all risks that are going hand in hand with long-term mechanical ventilation.
Next, infections. I talked about ventilator-associated pneumonia, but there’s also just a general infection risk because with a tracheostomy, in particular, you have an open airway more or less. It’s not completely open, but if it’s not being looked after properly, either in a hospital or at home, the risk for an infection is very, very high. Also, cardiovascular failure, so what do I mean by that?
Again, many patients that are in ICU have multiple comorbidities. They can often have cardiovascular failure, which means they have low blood pressure or hypotension. They end up on inotropes and vasopressors
. And also, because of all the pressures that are going into the lungs with positive mechanical ventilation, it also means there’s more pressure on the heart. So the heart has to almost pump harder to keep the blood flowing. So that could be a side effect too.
Next, diaphragmatic weakness and the atrophy and contractile dysfunction of the diaphragm. Why is that? If you’re not ventilated, the diaphragm actually stimulates your breaths. It almost triggers your breaths automatically. It’s a reflex. Whereas, if someone is mechanically ventilated, the ventilator is doing all the work. And that’s where not only the body gets deconditioned, also the diaphragm gets deconditioned. And again, that could lead to extubation failure, to weaning failure.
Next, we talked about the functional impairment. That’s just generally speaking. There’s also higher risk of readmissions back to ICU. Of course, there is. But then again, this is also where our service, Intensive Care At Home, is coming in that you’re not at risk of going back to ICU. That’s why we continue Intensive Care At Home so that you don’t need to go back to intensive care.
Next, as I said in the beginning, I want to recap those numbers because I think it’s very important that you hear those numbers again. It’s only about 5% of patients in intensive care that need prolonged mechanical ventilation for over 21 days. Out of those 5%, around 83% received a tracheostomy.
And really, besides the consequences that I mentioned in this presentation of the consequences of long-term mechanical ventilation, where it really should lead to in the long run is if someone can’t be weaned off the ventilator, or it takes a long time to wean them off the ventilator, they should be going home with Intensive Care At Home.
That is the best alternative for those patients. Continue Intensive Care At Home. Quality of life improves, mental health and wellbeing improves not only for patients, it also improves for their families, of course. Because if you have a loved one in intensive care, you know where you don’t want to spend your time. You don’t want to spend your time in ICU. You want to spend your time at home in an environment that you’re in control in. You know that you’re not in control in intensive care.
And I would really like to stress that irrespective of the doom and gloom of doctors and nurses in intensive care, a lot is possible at home. We have genuine long-term intensive care patients at home with ventilation, with tracheostomies and they live a very good quality of life. Their families live a much better quality of life.
You can look up our case studies at intensivecareathome.com. Now, I just want to take a quick break here, and just want to give you the opportunity to ask questions. Now, I’ve pretty much gone through the most important points of my presentation. I will talk a little bit more about Intensive Care At Home in a minute.
But I really want to give you the opportunity to ask any questions now to today’s topic, or if it’s not to today’s topic, please type your questions in as well so I can answer them. If you want to call in live on the show and you want to ask your questions live over the phone, I can dial you in.
You can call me for our US audience on 415 915 0090. That is again for our US audience, 415 915 0090. For our audience in the UK, you can call me on 0118 324 3018. That is again, 0118 324 3018. And for our viewers in Australia, you can call me 041 094 2230. That is again, 041 094 2230.
Okay. So yes, the next step really is for you not to buy into the doom and gloom and the negativity of intensive care teams and really do your own research. And there are a lot of intensive care units now that work with us, they’re very happily working with us. But intensive care is also a very conservative environment, very conservative industry, where there is still no perceived alternative in intensive care for someone besides: (a) leave intensive care and go to a hospital ward or to a hospital floor or (b) a patient is going to die.
In many people’s head in intensive care, there is still not the third option that we’ve been providing for over 10 years, and other countries have been providing for over 20 years now, which is Intensive Care At Home. It’s a proven model, proven concept that creates win-win situations for all parties involved.
Hi, Helene. Nice to see you again. I’ll just quickly get to your question. “When a patient is in Intensive Care At Home, do you service, help patients to get weaned off the ventilator if there is an improvement?” That’s a great question, Helene. So it really depends on a patient’s condition.
So let me give you some examples where we have helped patients to wean off a ventilator. And I’ll give you some example where we haven’t helped and we can’t help. So let’s just quickly start where we have been able to help. It’s especially children, where we have been able to wean them off a ventilator. It’s predominantly for premature babies that end up in NICU. Then they go on to PICU with a tracheostomy with ventilation. And then eventually, they go home with a ventilator, with a tracheostomy. They will get weaned off the ventilator. They’re just going home with a little bit of CPAP or pressure support ventilation. Once CPAP or pressure support, ventilation is weaned off completely, then we’re working towards a decannulation of having the tracheostomy removed. That’s certainly something that’s been very successful on our end. Another option would be Guillain-Barre syndrome for adults. Many Guillain-Barre syndrome patients recover. Not all of them, but many. Especially, with immunoglobulin therapy. And they can be weaned at home as well.
Now, where is it where we can’t wean? So for example, we have some patients at home with a C1 spinal injury, they are quadriplegic. Unfortunately, there’s no hope for recovery at this particular point in time. So those patients are not in a position to be weaned. Other patients that are not in a position to be weaned are patients, for example, with cerebral palsy, they have a ventilator, tracheostomy, motor neuron disease. They’re progressive diseases in nature. And those patients, unfortunately, at this particular point in time, unless there’s going to be a cure for those diseases somewhere down the line, are unable to be weaned off the ventilator. I hope that answers your question, Helene.
And also with what I talked about before, specifically, that prolonged mechanical ventilation in ICU and outside of ICU deconditioned very quickly, which then makes it more difficult to wean them off the ventilator.
A lot of it also comes down to what are the goals of care for a patient? What that means is, someone with motor neuron disease, for example, is not going home to be weaned off the ventilator. So the goals of care are: comfort, quality of life, spending quality time with their families and so forth. Whereas, the examples that I gave with children in particular, there’s a different approach there in terms of, what are the goals of care for an 18-month-old toddler versus an adult with motor neuron disease?
So that’s just some examples there. What other questions are there? And while I’m waiting for your questions, I’ll just keep talking a little bit more about Intensive Care At Home where discharge can be facilitated from intensive care to Intensive Care At Home with 24 hours intensive care, home care nursing, we can help you or even provide equipment. We’re certainly providing the staff.
That’s how we, generally speaking, make Intensive Care At Home possible. There’s also an overseeing doctor that takes care of the medical coverage, and then it’s a safe setup at home. But I will not have intensive care units talk about quality of life, saying people won’t have any quality of life. Most of them haven’t even seen an Intensive Care At Home setup.
It’s very immature to talk about quality of life at all if they haven’t even seen the setup and they haven’t even worked in this space. Ask patients, ask their families what they want. What is quality of life for them? Not what is quality of life for ICUs. That’s irrelevant. Completely irrelevant. It’s entirely up to you.
What other questions does anyone have to today’s topic before I slowly wind up today’s topic? While I’m waiting for your questions, if you’re finding value in this video, share it with your friends and your families, please. And subscribe to my YouTube channel, and give the video a thumbs up. Give it a like.
Now, Helene, you mentioned patients suffer aspiration pneumonia because of lying flat. “Should it be a protocol, if possible, to have bed positioned by a 30 degree angle?” Great question, Helene. So you would’ve heard me say earlier that there’s a risk for ventilator-associated pneumonia in intensive care, or for anybody on prolonged mechanical ventilation.
Now, when the first studies came out about ventilator-associated pneumonia, I’d say, about 15 years ago was when I first heard about the studies about ventilator-associated pneumonia in intensive care, those studies came with guidelines what to do to prevent ventilator-associated pneumonia. And part of the guidelines was head of bed elevation by 30 degrees.
And when I talk about lying flat, I’m not talking about lying flat for prolonged periods, but there are situations in ICU, or at home as well, where you simply can’t eliminate lying a patient flat. You might have to turn them and you might have to do an enema and you have to lie them flat, even though it’s for a short period of time.
Now, the recommendations are that if you do that, and you know you need to do it, to stop feeds maybe half an hour before you do that. Now, as part of the VAP prevention or VAP prophylaxis, ventilator-associated pneumonia prophylaxis, other things that need to happen is gut protection. So what do I mean by that?
They’re getting early feeding, which you might think goes counter with aspiration. But you need to feed early because that’s gut protection in and of itself. So the risk of not feeding is much higher of feeding early and taking the aspiration risk into account and managing it. Because if people don’t get fed in ICU, they are at high risk of gastric ulcers or gastric bleed. So early feeding is very important.
I hope that answers your question there, Helene. So give the video a thumbs up, share it with your friends and family, subscribe to my YouTube channel for updates for families in intensive care, comment below what you want to see next or what questions you have, like Helene is doing now.
And the video is recorded today. It’ll go up live very soon after this recording. You can watch it in your own time. And I do these YouTube lives every week, once a week. At the moment, usually on a Saturday night, 8:30 PM, Eastern Standard Time in the US, which is 5:30 PM Pacific Time in the US, 10:30 AM Sydney, Melbourne time in Australia on a Sunday morning.
Also, have a look at our website, intensivecarehotline.com and intensivecareathome.com. On both websites, you can call us with any of your questions or you can simply send us an email to [email protected]
Is ARDS a form of pneumonia? One could argue yes, especially with COVID lately. ARDS often follows COVID pneumonia. Basically, what happens with pneumonia, you’ve got bacterial or a viral or sometimes a fungal pneumonia and certain parts of the lungs are affected.
And you get stiffness of the lung, when you do a chest x-ray, you get certain areas of the lungs being collapsed because of the infection. So that’s pretty much what a pneumonia looks like. But there are other parts of the lungs that are not collapsed and that are functioning. Now with ARDS, it stands for acute respiratory distress syndrome, also known as lung failure.
Now, if you take the chest x-ray of an ARDS patient versus a pneumonia patient, the ARDS means there’s often a complete whiteout, which means all areas of the lungs are collapsed, making it very difficult to ventilate someone at all, which is why one treatment form for ARDS, or two treatment forms, major treatments forms for ARDS are: (a) head down, which means prone position, draining fluids out of the lungs, or (b) probably where it’s heading at the moment is ECMO.
So the lungs can actually take a rest. And if the lungs can have a rest, that gives time for the lungs to rest and heal. And then hopefully, you can remove ECMO at some point and let the lungs breathe by themselves again. So that’s the major difference there.
Also, you should have a look at our membership for families in intensive care at intensivecaresupport.org, where we provide a membership for families in intensive care. And also, we do medical record reviews for our clients, which is not very difficult in this day and age. Most medical records are now accessible online. The hospital should just issue you with a username and a password and voila, you should have access to the medical records in no time.
And we can help you with reviewing them and give you all the clinical insights and what it all means. So you’re not held hostage by the intensive care team, who probably only tells you half of the story. I also provide, one-on-one consulting and advocacy for families in intensive care. And I have options there.
Now, I slowly want to wrap it up there today, unless there are any other questions. I will do another YouTube live next week. At the same time, I would love to see you all again. Spread the word. I will tell you what next week’s topic is. I just quickly need to look at my schedule and then I can tell you what next week’s topic is.
Next week’s topic is: “The ICU team is negative about my dad’s condition, but is their hope?” And I will do a live stream about that next week. Now, Helene, “What is the clinical name of ventilator pneumonia?” So in ICU terms, the most recent term that’s being used is ventilator-associated pneumonia or VAP, ventilator-associated pneumonia.
It’s a reasonably recent term. That’s come up only in the last 15 years when the first research papers have come up. So that is the term that’s being used in ICU. But then bear in mind, Helene, there are also plenty of patients coming into ICU with a pneumonia, with a community-acquired pneumonia, whether it’s COVID or something else where it’s not ventilator-associated pneumonia.
But the ventilator-associated pneumonia is probably more coming in down the line in ICU. If someone comes into ICU with a community-acquired pneumonia, assuming they can treat the community-acquired pneumonia with antibiotics, with antivirals, whatever the case may be, and then it’s going away, but the patient is still ventilated. That’s when they’re at risk of developing a ventilator-associated pneumonia. So I hope that clarifies and helps there.
Now, if there are no other questions, I do want to wrap this up. I would love to see you all again next week, around the same time. If you can spread the word. There are many families in intensive care that need our help. Spread the word, get them on the show here, get them to ask questions. And I would love to help as many people as I can.
“Does the bacteria come from the ventilator?” It can. So it really depends. It’s often hard to say the origins of an infection. So how do infections get transmitted in intensive care? Take a doctor or a nurse or a respiratory therapist, for that matter. Many of them look after or have contact with more than one patient directly or indirectly. They either go next door to do some work with the other patient and that patient has an infection.
Or if they’re not doing that, then maybe doctors are spreading the infection, maybe families are spreading the infection. So it’s hard to say, Helene, if the infection always comes from the ventilator. Keep in mind, what makes it risky on a ventilator is you’ve got an airway tracheostomy or breathing tube that is susceptible to bacteria or viral stuff going in because the entry to the lungs is shortened and you’ve got a direct entry.
So it’s hard to say whether the ventilator-associated pneumonia is caused directly by the ventilator or whether it’s coming externally. But the biggest risk is that there is a direct entry into the lungs. And with the tracheostomy in particular, you’ve got a hole here in your neck, and with that hole in the neck, there’s just room for bacteria to enter the trachea. It’s just a massive risk there.
And ICUs, for lack of a better term, and I put it in quotes, ICUs are “dirty” because there’s so many infections from other people. It’s one of the most highly infectious environments there ever can be. Whereas, in a home care environment, there’s minimal risk for getting an infection.
“Is that MRSA?” MRSA is just one form an infection. It’s just one. MRSA stands for Multi-Resistant Staphylococcus Aureus. So it’s just one form of an infection. That’s all. There are so many infections. MRSA could be a pseudomonas infection, there could be a klebsiella infection, there could be 25 other infections. Just one form, the MRSA. But the MRSA is also a very common form of infection in ICU, unfortunately.
What other questions are there before I wrap this up today? If there are no other questions, I do want to wrap this up. We went for 50 minutes today. I’m looking forward to seeing you all again next week. “Is MRSA a pneumonia?” It can be, but it doesn’t necessarily have to be. MRSA can also be in the blood. It can be in the lungs. MRSA can develop into pneumonia, and often does if it’s in the lungs. But it doesn’t necessarily have to be in the lungs. That’s where it mostly colonizes.
You are welcome, Helene. You’re very welcome.
I hope that helps. I want to wrap this up for today.
Thanks for watching, thanks for sending your questions through. I’ll see you all again next week at the same time.
Share the video with friends and families. Tell people about Intensive Care Hotline and Intensive Care At Home and I look forward to seeing you all again next week. Take care and have a wonderful rest of the weekend.
Now, if you have a loved one in intensive care and you want to go home with our service intensive care at home and if you want to find out how to get funding for our service and how it all works, please contact us on one of the numbers on the top of our website, or send me an email to [email protected] That’s Patrik, just with a K at the end.
Please also have a look at our case studies because there we highlight more about what we can do for clients, how clients can live at home with ventilation and tracheostomies and you can look at our case studies as well at our service section.
Intensive care at home Case studies
And if you are at home already and you need support for your critically ill loved one at home, and you have insufficient support or insufficient funding, please contact us as well. We can help you with all of that.
And if you are an intensive care nurse or a pediatric intensive care nurse with a minimum of two years, ICU or pediatric ICU experience, and you ideally have a critical care certificate, please contact us as well. Check out our career section on our website. We are currently hiring ICU and pediatric ICU nurses for clients in the Melbourne metropolitan area, Northern suburbs, Sunbury, Bendigo, Mornington Peninsula, Bittern, Patterson Lakes, Frankston area, South Gippsland, Drouin, Warragul, Trida, Trafalgar and Moe as well as Wollongong in New South Wales.
So we are also an NDIS, TAC (Victoria) and DVA (Department of Veteran affairs) approved community service provider in Australia. Also have a look at our range of full service provisions.
Thank you for watching this video and thank you for tuning into this week’s blog.
This is Patrik from Intensive Care at Home, and I’ll see you again next week in another update.