74 year old Mom's in LTAC on 80% oxygen on the ventilator&trache, does she need to be back to ICU?

https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-74-year-old-moms-in-long-term-acute-care-ltac-on-80-oxygen-on-the-ventilator-tracheostomy-does-she-need-to-be-back-to-icu/

My 74 year old Mom is in LTAC on 80% oxygen on the ventilator & tracheostomy, does she need to be back to ICU?

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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, currently, we are working with the client who has their 74-year-old mother in LTAC (Long-term acute care). And she’s been in LTAC for about 10 days. So, this is obviously a client in the U.S., and the client’s mom had a heart attack in July 2022. Ended up in catheter lab with some stents to recuperate blood flow to the heart. And she also then had triple bypass surgery in the middle of July 2022.

She then ended up with a tracheostomy on early August 2022. She was unable to be weaned, and was very slow to wake up. She had been on midazolam, Versed, propofol, and fentanyl for long periods of time. They have done a CT (Computed Tomography) scan of the brain and an MRI (Magnetic resonance imaging) scan of the brain, which shows that she has no damage, which means she should be waking up.

But as we all know, it can take a long time sometimes after an induced coma, especially after prolonged induced coma to wake up, to make things more complicated. The client also had a retroperitoneal bleed because she was on heparin initially probably to keep the stents patent. They stopped the heparin and inserted the vena cava filter. And since then, there haven’t been any further issues with either bleeding or with any blood clots.

Furthermore, she’s very swollen with albumin low, and she’s also on Lasix, kidneys and liver are fine. Now, the family reached out to us and said, “Look, she’s been in LTAC now for 10 days, the ICU only gave us not even 24 hours warning to send her to LTAC.” They had no opportunity to select an LTAC. They had no opportunity to talk to the LTAC. They just literally dumped her into an LTAC.

Now, if you watch any of my videos for any length of time, you would’ve heard me saying that LTACs are not safe for our intensive care patients. And if someone is on a tracheostomy with so many complications like this lady, she should not go into an LTAC.

And the family has been reaching out and saying, “Look, she’s been in LTAC for 10 days now. She was doing reasonably well in ICU. She was breathing spontaneously on CPAP (Continuous positive airway pressure) and pressure support for periods of times.” But since she’s been in the LTAC, she’s been totally neglected and they fear that things will get worse. So they reached out to us and they became a client and we set up a phone call with the LTAC. It turns out that the lady is now in LTAC on 80% oxygen.

Now bear in mind, room air, the air that you and I are breathing is 21%. And this lady is on 80% of oxygen in LTAC. Now, when we had the nurse on the phone that was looking after this lady I asked her, what are her arterial blood gases? And she said, she wouldn’t know.

Now that’s dangerous. And in my mind that is medical negligence. A patient on 80% of FIO2 (Fraction of Inspired Oxygen) should be in ICU with a pneumonia and should be looked after properly by an ICU team because she’s critically ill. Now, if a nurse looking after this lady doesn’t know what her arterial blood gasses are like, that’s dangerous. And it’s medical negligence in my mind.

Now to top it all off, the nurse confirmed that there’s no doctor on-site in an LTAC. Well, we know that, we are not surprised by that because we’ve been dealing with families that have loved ones in LTACs for many years, we know that. So it comes back to my original point.

Continue reading at: https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-74-year-old-moms-in-long-term-acute-care-ltac-on-80-oxygen-on-the-ventilator-tracheostomy-does-she-need-to-be-back-to-icu/