Navigating Critical Care: A Father's Battle with Pneumonia and Ventilation

Q: Navigating Critical Care: A Father's Battle with Pneumonia and Ventilation

Dear Ms. <br>Tsai： It is advisable to perform a tracheostomy if you cannot be weaned off the ventilator in the short term. <br>Keeping a chopstick in your mouth continuously is quite uncomfortable. <br>After the tracheostomy, you can still train to wean off the ventilator. <br>If

Dad is intubated in the intensive care unit?

Hello, doctor.
My father went to the emergency room in early March due to physical discomfort, which was diagnosed as a urinary tract infection (after chest X-ray and CT scan) leading to fever and sepsis (with a white blood cell count of 26,000).
He was hospitalized for a week and then discharged.
However, during his hospital stay, my father had persistent coughing and felt short of breath.
The doctors did not focus enough on his condition, missing the critical treatment window.
As a result, he was readmitted just a week after discharge and went directly to the intensive care unit (with oxygen saturation below 90%).
After two days, his oxygen levels remained unstable, and the physician recommended intubation and starting antibiotic treatment (due to elevated inflammatory markers and high white blood cell count).
After some fluctuations in his condition, another CT scan revealed that more than half of his lungs had developed fibrosis (worsening within a month), along with pneumonia.
The doctors have now identified appropriate antibiotics to treat the pneumonia, but my father seems unable to be weaned off the ventilator.
The physician has also suggested a tracheostomy, which makes it difficult for the family to decide.
I would like to ask if there are any better recommendations, considering my father has been intubated for 17 days.
We are concerned that even after a tracheostomy, he may still be bedridden, leading to a loss of quality of life, which puts us in a dilemma.

Dai Xiaojie, 30~39 year old female. Ask Date: 2023/04/06

Dr. Huang Yiwen reply Pulmonology

Dear Ms.
Tsai: It is advisable to perform a tracheostomy if you cannot be weaned off the ventilator in the short term.
Keeping a chopstick in your mouth continuously is quite uncomfortable.
After the tracheostomy, you can still train to wean off the ventilator.
If it is truly impossible to wean off, there are portable options available, allowing for mobility rather than being bedridden, unless your condition does not permit activity.
There is also Level 4 home care available, which is covered by health insurance.
A tracheostomy is not a bad thing, so there is no need to be overly pessimistic; it is just a step in the management process.
Changhua Hospital cares about you.

Reply Date: 2023/04/06

More Info

Navigating critical care for a loved one, especially a parent, can be an incredibly challenging and emotional experience. Your father's situation, involving pneumonia, ventilation, and the potential need for a tracheostomy, raises several important considerations that require careful thought and discussion with the medical team.

Firstly, it’s essential to understand the context of your father's health. He has a history of urinary tract infections that led to sepsis, which is a severe and life-threatening response to infection. Following his initial hospitalization, the development of pneumonia and subsequent respiratory failure necessitated the use of a ventilator. The fact that he has been on a ventilator for 17 days indicates that his respiratory status is precarious, and the medical team is likely weighing the risks and benefits of continuing invasive ventilation versus transitioning to a tracheostomy.

A tracheostomy is a surgical procedure that involves creating an opening in the neck to place a tube directly into the trachea (windpipe). This can provide a more stable airway for patients who require prolonged mechanical ventilation. It can also facilitate easier weaning from the ventilator and improve comfort. However, the decision to proceed with a tracheostomy should be made with careful consideration of your father's overall prognosis, quality of life, and potential for recovery.

Here are some key points to consider:
1. Assessment of Prognosis: Discuss with the medical team about your father's overall prognosis. What are the chances of recovery from his current condition? Are there underlying issues, such as lung fibrosis, that may complicate his recovery? Understanding the expected outcomes can help guide your decision.

2. Quality of Life: Consider what quality of life means for your father. If he were to undergo a tracheostomy, what would his daily life look like? Would he be able to communicate, eat, and engage in activities he enjoys? It’s important to have an open dialogue with the healthcare team about what life might be like post-tracheostomy.

3. Ventilator Weaning: Ask about the potential for weaning him off the ventilator without a tracheostomy. In some cases, patients can be successfully transitioned off mechanical ventilation with intensive rehabilitation and respiratory therapy. Understanding the plan for weaning can provide insight into whether a tracheostomy is necessary.

4. Family Support and Involvement: Engage with the healthcare team and express your concerns and wishes for your father's care. Family involvement is crucial in decision-making processes, especially in critical care settings. Ensure that your father's values and preferences are considered.

5. Palliative Care Consultation: If the prognosis is poor and recovery seems unlikely, it may be beneficial to involve a palliative care team. They specialize in providing relief from the symptoms and stress of serious illness, focusing on improving quality of life for both the patient and the family.

6. Emotional Support: This is a difficult time for you and your family. Consider seeking support from counselors, support groups, or chaplains who can help you navigate the emotional challenges of this situation.

In conclusion, while the decision to proceed with a tracheostomy can be daunting, it is essential to weigh the potential benefits against the risks and impact on your father's quality of life. Open communication with the medical team, understanding the prognosis, and considering your father's wishes will be crucial in making an informed decision. Remember, you are not alone in this journey, and seeking support from healthcare professionals and loved ones can help you navigate this challenging time.

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