AboutHillarie Speziale Expertise I can answer general questions about ICU care, the frequently used medications, procedures, and life supports. I can also explain many of the diagnoses and supportive measures used for patients with that particular illness. I am familiar with the infectious, cardiac, pulmonary, renal, and gastric problems that can land you in the ICU. I can not tell you exactly how long the patient stay will be, diagnosis your symptoms, or tell you with any certainty that the care you (or your loved one) received was wrong. I can also answer career questions regarding RRT and RN fields. Please note: neurology is not a field I have a great deal of familiarity with..
Experience I have 17 yrs experience as a Respiratory Therapist, and 9 yrs as a critical care nurse. I am familiar with infectious, cardiac, respiratory, renal and gastric diagnoses that can land you in the ICU.
Education/Credentials Assoc. Degree in Respiratory Therapy, Bachelor of Science in Nursing, Master of science in psychiatric nurse practitioning.
Expert: Hillarie Speziale Date: 5/19/2008 Subject: 83-Year Old Mom in ICU on Ventilator
Question Hi Hillarie,
My 83-year old mom has been in ICU for 24 days and intubated 21 days, with a trach 2 days now. Her diagnosis was BOOP pneumnia, ARDS. After the lung biopsy almost two weeks ago, they took her off the sedative propapyl (sp?). She "woke up" about a week ago but still cannot move her arms, legs and is very swollen and leaking fluid from her hands. She has a chest tube, feeding tube, etc. and I am wondering if she will ever be able to lead a normal life again. We have been told the pulmonologist will do everything he possibly can just to save her life but we know she would not want to live on a ventilator all her life. He just keeps stringing us along saying she "could" get better. There was an EEG done a couple of weeks ago that showed no signs of stroke. She is also on insulin (she wasn't a diabetic before this occurred) and steroids for the BOOP. Any advice you can give would be helpful. My mom was very active before this and she was also a heavy drinker and went through DTs when they first brought her in.
Answer Hi Kitty,
So sorry to hear about your mom. BOOP and ARDS can be survived. BOOP can often be completely reversed. ARDS is not so easily typified. It may clear, but it can leave a fibrotic lung disease. The profound weakness you're describing may be critical illness polyneuropathy. It occurs in patients following a severe illness such as ARDS, sepsis, and multisystem organ failure. It usually responds to intensive physical therapy. The swelling, or edema, may be related to her nutritional status, but is also a product of being on the ventilator. It's positive pressure, instead of the negative pressure the chest cavity usually operates in, causes a decrease in the return of venous blood and lymph fluid.
I don't think the physician is being purposefully evasive. It's true that she may survive this. It can be difficult to justify giving up on a patient once they are over the hump and actually beginning to rally. I can understand your fears as well however. The oft cited rule of thumb is 3-5 days of rehabilitation for every one day in the ICU. The trach should help her weaning, but there is no guarantee she will be completely free of the vent. She may require night time ventilation and be off during the day.
I realize this doesn't offer any real direction to take. Unfortunately, there just are no easy answers. It's so individual. I have taken care of people I thought absolutely could not survive, and they came back to thank us for not giving up. There are other patients that I thought were days from leaving the ICU and returning home that turned some strange corner that very afternoon and passed away.
I hope the information is at least of some help. Take care, Hillarie
