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Question
7 days ago my father (83) ended up in ICU with sepsis and septic pneumonia. What started as a trip to the ER for a blockage turned into the worst week of my life. During a simple procedure involving a tube down his nose into his stomach, he aspirated the contents of his stomach into his lungs. Meticulously, he survivived despite every doctor telling us he would die. One thing is for sure he is a fighter. In 2 weeks his fever down and BP stabilized without medicine. His lungs unfortunately still show no improvement. He is on 3 different antiobioics. Our immediate crisis is that my father is dependent on the ventilator and we are now being told about a tracheotomy. We have had 3 different ICU doctors and all of them have discussed the trach and everything involved. The last ICU doctor said it would be easier to wean off the trach then the ventilator. The new ICU dr of the past couple of days has decided to tell us, in the last days, that if my father went on the trach he would end up spending the rest of his life hooked up to machines living in a nursing home. I immediately called his internist (who is here everyday) who did not agree with that statement. Bottom line is, my fathers issue weaning is because of all the fluids they give him to keep his BP up. When they give him lasix it helps his weaning (lasted 4 hours the other day compared to the 30 minutes today) but then his BP drops significantly. We need a solution

Answer
Dear Stacey,

I agree with the internist. Not only will it be easier to wean your father off the trach, but it will make it much easier for him to communicate. I cannot promise that he will be independent of the ventilator, but at some point a decision needs to be made to either trach him, or take him off the ventilator and put him on comfort measures. The endotracheal tube will eventually cause erosion on the trachea.

As far as his blood pressure, his blood pressure is low because his circulatory system is dilated. Secondary to infection, inflammation, heart failure and age, the blood vessels are not constricting well enough to properly pump the blood back to the heart. This is when he will have swollen ankles and/or fluid in his lungs. The Lasix gets rid of the extra fluid, but decreases the amount of fluid in the body, dropping his blood pressure. Only medication can help this; either a drug to help the heart to better contract, or a drug to help the body constrict the peripheral blood vessels. I imagine that he is on these medications, and now it is a waiting game for when his body will respond.

In closing, do not be afraid of the trach. If anything it will give him some comfort and a way to communicate.  

ICU/Critical Care

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Dr. Pamela M. Cipriano, DNP, ACNP-BC

Expertise

My name is Dr. Cipriano. I am able to answer questions regarding critical care issues including the cardiac system, pulmonary system, gastrointestinal system, gallbladder, small bowel obstructions, crohn's disease, diverticulitis, general abdominal surgery, ventilator management, ARDS, dehydration, heart failure, kidney failure, shock. pneumona, surgical complications, disease process.

Experience

I am a Hospitalist at a local hospital and in the emergency department. I am on the Medical Staff. I round, admit, discharge, consult and assist with surgeries in the OR. I manage patients in the ICU and Med/Surg floors.

Organizations
Society of Hospital Medicine American College of Nurse Practitioners Connecticut Advance Practice Nurse Society

Education/Credentials
Maryville University 2014-2016 Doctor of Nursing Practice University of Connecticut 2007-2011 MSN, Acute Care Track Nurse Practitioner. Board Certified September 2011 Central Connecticut State University 2002-2006 BA Psychology St. Mary's Hospital School of Nursing 1991-1993 Diploma Nursing Registered Nurse

Awards and Honors
Golden Key Honor Society; Merit Award Recipient; Scholarship Recipient

Past/Present Clients
Trained at Hartford Hospital, Hartford, CT - Open Heart Cardiac Intensive Care Post Anesthesia Care Unit & Radiology Internship Interned at MD Anderson Cancer Center in Texas Trained at St. Mary's Hospital, Waterbury, CT - emergency Department & Hospitalist Program

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