Dad on vent/trach for 3 weeks battling covid. Bre... - ICUsteps

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Dad on vent/trach for 3 weeks battling covid. Breathing over ventilator...

TB07 profile image
TB07
16 Replies

My dad has been in the ICU intubated via trach for 3 weeks now. He has gotten down to as low as 60 on oxygen and low on sedatives fentanyl and versed, but has recently had to go back up to between 90-100 c02 most days. He has these “episodes” almost every night when they start to wean sedation where he tries to breathe over the vent rapidly and it causes his o2 stats to drop and they have to raise his oxygen again. They said his x days look like he has extensive fibrosis, but they can’t be sure. The drs have very little hope and have suggested comfort care and signing and DNR. My dad is only 56 and explicitly said he wants every chance to fight bf being intubated. I keep reading stories of people needing more weeks on the vent...Has anyone else experienced this and seen recovery???

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TB07 profile image
TB07
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Sepsur profile image
Sepsur

I tended to dip at night, one of my nurses gave me a really good explanation, alas, I forget her exact words but what she talked about was quite a complex picture & combination of reasons. Sleep deprivation in ICU is a common legacy of ICU but ironically, we are still governed by circadian rhythms all the same. Levels of certain hormones drop quite dramatically, the stress hormone cortisol for instance which affects the airways in a way that there is a less efficient transfer of Oxygen into the blood stream and expelling carbon dioxide.

If you imagine a typical hospital day - we are messed around with all morning, even when we are sedated, we’ve probably received physio - so the body hasn’t been as static as it is over night. That period of stillness allows fluids to build up and affect bodily function.

Blood sugars are at their lowest - we tend we get breakfast at 8, lunch at 12 and dinner at 5pm.

Any medication might be at its lowest level at night.

Even the body temperature dropping slightly at night, affects the lung function.

This passage describes someone who has COPD for instance.

“ Chronic obstructive pulmonary disease (COPD) describes a collection of conditions causing lung damage, including chronic bronchitis and emphysema, causing inflammation in the lungs, often along with permanent damage to the airways.

In a recent study, 76 per cent of COPD patients reported frequent night-time wakening because symptoms worsened at night.

Studies have found less air passes through lungs during deep sleep, and dropping body temperature at night affects lung function.

The body also responds less efficiently to increasing carbon dioxide levels in the blood during sleep, so breathing rates do not rise in the same way as during the day to expel it from the body.

Excess carbon dioxide eventually causes someone to wake up, often gasping for breath and 'oxygen-deprived'. This leads to exhaustion and worse symptoms during the day.”

TB07 profile image
TB07 in reply to Sepsur

Do you know what kind of vent settings they had to use on you? Peep? Oxygen levels? Sedation? Lung paralytic?

Sepsur profile image
Sepsur in reply to TB07

Firstly I was intubated upto about day 55 - then trachy when awake for approx 2 weeks, then CPAP, PEEP, nose prongs finally.

My lungs failed, my heart failed. I was proned which needed heavier sedation. Don’t know which ones.

There was a moment where I couldn’t tolerate intubation, so a nurse kept me going on an ambu-bag.

They did not think I would survive the night, on a few occasions my wife came and said her goodbyes

Mccarthy0702 profile image
Mccarthy0702

Hang on in there my dad did 73 days on ventilator back in March with covid . On and off kidney dialysis for the first 6 weeks and very similar to your dad for first five weeks very up and down with his oxygen requirements. He has been home now since June with no lasting damage to his kidneys but does have some scarring of his lungs . Please just try to remain positive while your dad is fighting you fight for him xxx

TB07 profile image
TB07 in reply to Mccarthy0702

Thanks for your message, and glad to hear your dad is home now ❤️ Do you remember your dads vent settings in the early weeks? My dad has gone between 15 on the peep down to 10 and his oxygen has fluctuated between 60-100. He has been highly sedated on fentanyl and versed the whole time. They go off and on the lung paralytic based off of his oxygen levels and if he’s satting high or low. His body has held sturdy otherwise. No kidney damage, liver ok, pancreas ok. Just struggling with his lungs. They believe that when they lower his sedation he will start to try to breathe over the vent and his oxygen will drop. They think his lungs are too damaged and don’t give us much hope telling us to consider comfort care. But, we still have hope and the think maybe he just needs more time to heal.

Mccarthy0702 profile image
Mccarthy0702 in reply to TB07

Dad was a pretty similar pattern during the early weeks very up and down with oxygen levels , peep on high settings also . During them early weeks I became fixated on the numbers but as time went by just took the small positives and tried to concentrate on the small improvements. Once dad came off the sedation he’s was still very agitated due to the delirium he was suffering .

During the first five weeks his lungs where pretty bad and filled with fluid so he had a pleural infusion and drained about three litres of fluid and from then on his condition seemed to stabilise.

I would say as with most covid patients it’s still early days and it’s sometimes a long weaning process because of the lung damage . Hope this helps . Praying you get some better news in the coming days xx

Cazthomp profile image
Cazthomp

Keep hope my mum was there for nearly 2 months xxx

TB07 profile image
TB07 in reply to Cazthomp

How is she now?

Cazthomp profile image
Cazthomp in reply to TB07

Home and doing well

Sonya1114 profile image
Sonya1114

Hi TB07 , sorry to hear about your dad’s current icu state. My dad was in the same shoes as you describing. Unfortunately, this seems like the common protocol with COVID icu patients in the states in recent stages of the pandemic. If a patient’s condition does not significantly improve in the first 3-4 weeks in the ICU, doctors rush to suggest the DNR, not leaving any hope for the family. Having gone through this with my own dad, if I can go back and do one thing differently, I would insist and demand a 2nd, and possibly even a third opinion, of an independent doctor (one who doesn’t work for the hospital), prior to signing a DNR. Problem is these days, doctors/nurses are immune to any liability for wrongdoing to COVID patients, and because it’s not their own family member, give up way too soon. I wish you a different outcome than what I’ve experienced. Stay strong and don’t give up.

The following article, in support of my statement:

ncbi.nlm.nih.gov/pmc/articl...

TB07 profile image
TB07 in reply to Sonya1114

Thanks for sharing your experience. I’m sorry for your loss. I appreciate hearing your opinion so much. They keep telling us if we get to the point of him needing CPR it’s way too far gone to bring him back. My dad was clear that he wanted everything done to give him a shot at recovering so signing a DNR seems like going against his wishes.

Sonya1114 profile image
Sonya1114 in reply to TB07

We were told exactly same thing. My dad died in a hospital in NYC. They did honor our wishes to perform CPR, but hated us for making them do that. Obviously he didn’t make it after they began CPR on him.. It was a nightmare, the whole experience was a nightmare from start to finish. I wish you strength to advocate on behalf of your dad to the best of your ability.

TB07 profile image
TB07 in reply to Sonya1114

I’m so very sorry

Mcs1313 profile image
Mcs1313

So sorry your dad and all of you are going through this. Just here to offer support.. my mom has been in the hospital since November 14, intubated since December 14, and trached since January 3. Very similar situation… her vent settings have gotten down to 50% and at times they’ve had to go all the way back up to 100%, still all these weeks later. Just last month she was holding firm for a few weeks at 55% oxygen and a PEEP of 5, which was the lowest ever since she had been on the ventilator. She was slowly becoming more alert.. even smiled at me and squeezed my hand many times when we got to visit her once last week. They also were able to get her off all sedation drips and she was only on a fentanyl patch and Ativan scheduled through her feeding tube. All of a sudden we had to move her to a long-term care facility, and that very night she had an episode and now has been anywhere from 70% to 100% and PEEP of 10 on the ventilator. They also now have her on a fentanyl and propofol drip as well as scheduled Valium… Makes no sense. It’s like the plan that was going on at the hospital for her was not continued in this facility, and we are so frustrated and upset. Same with the sedation too like your dad… For a weeks every time they would try to wean down sedation my mom would become a little agitated and then they would have to adjust the ventilator and her sedation. We had a bad feeling that less care in a facility like this was going to result in her losing her progress.

We have been told the same thing about the fibrosis. They suspect it but aren’t positive. X-rays and CT scans don’t look great and have to improved in all this time. They also said that some people have survived with some fibrosis, so I don’t know what to do then. She’s also not had any other issues in this entire time— heart, kidneys, liver all good. No preexisting conditions, and a young 70 years old. We have also been told they don’t feel that she will ever get off the ventilator several times, and comfort care has been mentioned a few times. It’s breaking my heart, and I pray for a miracle every day.

Just praying for you and letting you know your family isn’t alone in this ♥️

TB07 profile image
TB07 in reply to Mcs1313

Thank you for reaching out, and I’m sorry for all you have gone through with your mom. This is such a cruel disease and a cruel way for patients to have to fight all Alone. I’m so glad you are able to visit her. We have not been able to visit yet, and it’s terrible. Prayers for your mom to keep fighting!!

Mcs1313 profile image
Mcs1313 in reply to TB07

The pain of not being with them is indescribable. I’m so sorry you haven’t been able to see your dad at all. We had to beg for ours or basically act like we were coming up for a “care conference” and then asked to see her when we were there. Hopefully places start to loosen restrictions soon. These patients need their loved ones so much.

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