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.
Question My 83 year old dad is hanging on for his life after gall bladder surgery. He
had a badly infected GB and had open surgery to remove it. The doctors think
he went into septic shock following the surgery. 2 days after the surgery he
became non responsive, had trouble breathing and had to be put on a
ventilator. He has now been on the vent over 10 days. He is receiving
Cardizem and Levofed, plus vasopressin to maintain his bp. He also receives
dialysis every 2-3 days. When they decrease his propofal dose he is
responsive, but I am concerned he can no longer breathe on his own. I
assume the next step would be a trach and they would keep him on the vent
longer, but how can you recover when you are lying in bed?
Answer Hi Doug,
As you questioned in your last note, Propofol, a sedative, can decrease blood pressure as well as respiratory drive. These issues, however, are off set by the quickness with which the body can metabolize it. Once the Propofol is turned down or off, the return of consciousness occurs within minutes. It's possible that once he's off the Propofol he may need less of the levophed and vasopressin. The sepsis, however, can also cause low blood pressure, which will gradually resolve.
In terms of the ventilator, right now he is dependent on the respirator. Weaning him from it is often a slow process. If the physicians push for a tracheostomy, that's not necessarily a bad thing. The fact is the tracheostomy does not have to be permanent, and it makes weaning from the ventilator easier. First of all its easier to breathe through the tracheostormy than a regular endotracheal tube. Secondly, it's much easier to take the patient off the ventilator briefly and return them to it as needed, so the weaning is enhanced.
There is not a lot of rehab that can be done until he can be freed from the ventilator. That's usually seen as the first priority. He could be placed in a chair. He can have physical and occupational therapy, but mostly we want them to conserve their energy to work on breathing. Rehabilitation generally begins in earnest once they are freed from the ventilator.
I hope this explains some of it. If there are things I have missed please feel free to write back with further questions. Hope he's beginning to recover even as I write.
Take care, Hillarie
