Infective endocarditis, influenza, fully ventilated.

[nurseinsa]

Hi, I'm a nurse, but new and not very familiar with intensive care nursing. My friend is now in intensive care and I am caring for his 10 yr old daughter. My friend 45, male, long term alcoholic, had tooth issues, then infective endocarditis, was at week 5 of IV abs in local hospital (700kilometers away from city) he was preparing for heart valve surgery, when he picked up influenza A. Retrieved to city hospital,

he was intubated and fully sedated, but would become unstable each time they tried to lift sedation. 24 days in they had him with tracheostomy and off sedation. 2 weeks later he continues to sleep all day including throughout nursing interventions. They are currently trying to wean off ventilator- they trial him 10 mins each hour, but said he has "ok days or days where he goes backward, not showing signs of progress"

It's so hard for me to get clear picture of what's going on, as doctors will never return our calls or emails and the response of the nurse depends on the day! Sometimes I call and they say in a chirpy voice that "he's doing great!" When I question further it basically means he's stable this shift - no sign of progress though. Most of the nurses don't know he has the heart issue, or that he has a daughter- even though I call each 2 days (sorry I'm venting a bit there!)

However, It's my nursing understanding that with underlying cardiac issue- he may not make it, or that after many months he may breath on own, but due to hypoxia may not be able to take on daughter again, may need carer himself. Am I way off base or on the right track? No one has said he was hypoxic, but surely there have been many opportunities?

[iluvgusgus]

I dont know how we could help you since we are not at his bedside, it might be worth the trip to see what is really going on, because hearing it over the phone and seeing it are 2 very different things.

[Biffbradford]

His family will just have to corner the attending physician and bombard him/her with questions. Perhaps it's time for a family conference where you gather the docs and a nurse and talk about his current treatment and future plans. In 15 years of ICU care, I've seen people who we thought would fly through treatment, only to not make it one night ... and others who we thought would never make it, end up walking out of there. Sometimes we tune 'em up as best we can, looking pretty good, send them to LTAC (long term acute care) and they bounce right back to the ICU next day, or they die. Yet others you never hear about again. It's very hard to predict outcomes and you just have to take the ups with the downs, take it step by step. Hope that helps. Best of luck.

[nurseinsa]

You're both right - it's very hard with the distance! and Thank you- I will request a conference, maybe then a doc will talk with us.

[Esme12, ASN, BSN, RN]

I am sorry about your friend. We cannot give medical advice as per the Terms of Service you need to get a hold of his family and request a meeting/conference call. You can call the hospital and ask for social service to help you and his daughter get some answers. If he doesn't do well and can't care for his daughter you need to look into family or what you can do for his daughter.

[karen flink]

Definitely ask for a conference and include his intensive care MD and/or the cardiac surgeon. Has he had another recent echo to see if vegetation on any leaflet of valve?(make sure to have them use contrast to check) How are his kidneys and liver doing on top of his cardiac and lung status? Can he be switched to other type of sedatives so he may not be so sleepy? Make sure to check for small bowel issues. Make sure he is not septic. Even with being ventilated, is he being sat up in a stretcher chair to enhance pulmonary status? You might try making recordings of his daughter talking to her dad to motivate him to get better. If he has a favorite football team, or TV show-make sure they turn it on-things like this may bring him back more quickly. See if you can work with the nurses to get him on a consistent schedule and make sure they are talking to him. He may have subconsciously given up. These are all just suggestions to ask