My dad has ARDS and Sepsis?!!?

In My Humble Opinion
1

My dear old dad does not appreciate doctors. I spoke to him on the day after Thanksgiving and he sounded quite ill. I asked how he was feeling and he advised that he’s had a cold since his wedding.

“Dad, your wedding was in September. Think you might wanna call a doctor??”

“Well, I didn’t want to be hasty about it.”

:smack:

He promised that he’d call the doctor the following week to setup an appointment, but by Sunday morning he was too sick to get out of bed and my stepmom ended up calling an ambulance for him. The doctors said medium to severe pneumonia.

On December 1, she called me in hysterics because the doctors decided to put my father on a ventilator. His oxygen level was 80something and they said that he couldn’t heal if he couldn’t breathe.

It is now December 20th. My father is still on a ventilator. I spend the weekend in Ventura visiting him… and it is the biggest nightmare I can imagine.

He is doped up on Adavan and probably doesn’t remember that I was even there. He only flicked his eyes open a few times in the two nights and one morning that I spent with him. There is a tube down his throat for air, a tube up his nose for food, a pick line into his heart for antibiotics and every 30 minutes the sound of his blood pressure cuff inflating makes my heart skip.

His oxygen level is between 98 and 100 with the vent on… and his BP is holding steady at 113/77 or so.

It’s been really difficult to get much information from the ICU on what exactly his condition is and how exactly they are attempting to control it. I’ve gathered that they’re still pulling phlegm from his lungs, they used the term Acute Respiratory Distress Syndrome brought on by pneumonia and I know they mentioned sepsis because he’s caught a bit of an infection (from the vent?) and they’ve mentioned a trachioskamy(sp?) to reduce his chances for infection from the vent and make him a bit more comfortable.

I am so scared that I cannot see straight. Why is this taking so long? Is he dying? Does anyone recover from being on a vent for almost a month? My dad is only 50 years old. He looks so out of place in the ICU… Who the hell stays in ICU for more than 3 weeks!!! I am just completely out of my mind and could use some support, however anecdotal.

The only experience I’ve had with vents and sepsis was when my grandmother was in the hospital earlier this year. This ultimately ended with me burying her and so you can pretty much guess how scared I am right now.

Anyone ever suffered or known anyone to suffer this severe of pneumonia (or I guess complications from…) and make a full recovery?

How long can he live like this? Why isn’t the inflammation in his lungs subsiding?

2

I have no experiences to help you with at all, I’m afraid. I just wanted to give you my best wishes, and to let you know you and your dad are in my thoughts. :frowning:

3

My sister-in-law, who is in terrible general health, had exactly the same problem. Respiratory illness and sepsis. She recovered, although she didn’t do much in the way of taking steps toward improving her general state of health, so she’s always generally sick. It sounds like they’re doing everything they’re supposed to do: antibiotics, ventilator, etc. Good luck.

4

I’m sorry that I can’t answer your questions. I just popped in to say that I’m sorry to hear your news - sending supporting thoughts your way!

5

Here is some basic information about ARDS

http://www.ards.org/

Here’s some more indepth stuff

http://www.merck.com/mrkshared/CVMHighLight?file=/mrkshared/mmanual/section6/chapter67/67a.jsp%3Fregion%3Dmerckcom&word=ARDS&domain=www.merck.com#hl_anchorto

I am not familiar with your fathers specific condition, but it sounds like he is very sick. His recovery is going to be very difficult and slow. It sounds like it will be complicated by the infection. Him being relatively young gives him a better chance for recovery.

I’d love to give you some encouraging words, and be able to say that your father will be just fine, but I really don’t know. Your fathers doctors will be in a much better position to tell you exactly what is going on. Read the links that are above so you have a basic understanding, and talk to the docs. They should be willing to discuss exactly what is going on and what they expect.

6

The only people who can answer your questions are the doctors. Next time you’re there, ask for answers, and don’t leave until you get them. You don’t need to guess and try to figure out for yourself what’s going on. They have very well-trained people there who know exactly what’s going on and can tell you.

Good luck.

7

Thank you all for your concern. I appreciate the links and the story about Kalhoun’s SIL. I don’t think I realized how serious his condition was until I started researching ARDS. Gah. Flippin’ pneumonia. Dr. said if he’d been in a week or so before, he would’ve been sent home w/ antibiotics and fine by now.

I’m devastated to put it mildly.

8

Promise to get some specific information from his doctors, okay? It’s good to understand the general concept of the disease, but his own situation and prognosis are going to be unique; don’t leave the hospital again without real information from the doctors. Violence can sometimes get people to talk when they wouldn’t otherwise - consider beating it out of the doctor if it’s necessary.

9

Just as a heads-up - doctors will not automatically provide that kind of information to any relative who asks, depending on what’s been told to them about who is allowed to get that information. If your dad’s wife has by chance been designated as the sole contact for health care info in his case, you may have to get it from her, have her around when you talk to the doctor, or have her tell the doctor that you are allowed to get this information.

I encountered this when my brother-in-law was in the hospital after liver failure - he also contracted severe pneumonia, had a trach done and was breathing on a ventilator/breathing tube that way, and had a stroke plus kidney failure. His liver actually managed to recover, kidneys started working again, and after some time in a rehabilitation facility, he was able to go home. His fiancee was the only listed person who could receive health care info on him; even his parents were not listed.

10

I would, but I’m 400+ miles from the hospital… so I do need to rely on my stepmom’s relay of information more often than not. She’s a sweetheart and she tries to get everything out as clearly as she can, but we’re both doctor stupid. Even so, I don’t know if I can hear “he has an X percentage of surviving” from a doctor right now. Maybe in a couple of days, but right now I’m pretty much at my breaking point.

11

It’s likely that the delayed treatment for the pneumonia caused the sepsis. Bacterial pnenomia doesn’t get better on its own. The pneumonia, complicated by the sepsis then likely lead to theARDS. (This is just another site, one of the others didn’t open for me.)

(my bolding)

A tracheostomy is a surgical hole in the lower part of the neck in which a smaller, more stable tube is secured. It decreases the chance of injury to the trachea, and the possibility of accidental removal of the breathing tube, which, in the case of ARDS, is life threatening. It is used most often in cases where ventilatory support must be long term. It can later be closed. Because ARDS takes a long time to heal, the tracheostomy might be more comfortable as well.

I’m afraid not everyone with ARDS survives, the percentage is less than 50%, but yes, people can recover from illnesses this serious, however, it may take a very long time.
Don’t lose hope, and trust that the medical team is working to save your dad.
It doesn’t hurt to ask questions, and asking the same questions over and over is even ok. They understand how stressful this all is.
My suggestion is that you call the ICU nurse on duty once a day. Next time you call, ask what the best time to call is, then call at that time each day.
When my dad was in the hospital I was 1000 miles away, I chose to call very late at night. The nurses on nights and evenings are not as harried as in the daytime, so they have more time to spend talking and explaining. Avoid calling between10 PM and 11:30 PM that’s when 8 hour shifts change and they are busy. The evening shift is also not as busy as the day shift, but nightshift will have the most time.

12

Well, my stepmom called again at 1am this morning. She said he was wide awake last night and that the doctor said he’s breathing more for himself than the machine is breathing for him now. They told her they’d like to try the lowest setting on the vent this morning sometime.

She called me about two hours ago and said that he is now only on the ventilator for CPAP, which is similar to what they do to sleep apnea sufferers to ensure that their airways stay open I guess. There’s no air being forced into his lungs, he’s breathing it in all by himself! Yaay! But the vent is still there to keep the airway open, I think.

She said that he was awake all night watching tv with her, crying alot and being a general emotional wreck. She promised him that it was normal and that things would get better real soon and she worked with his legs to keep him from sitting so terrifyingly still. She held his hand and washed his face and hung wrapping paper on his wall in the ICU. She showed him the card and little catholic placard for healing that I bought him while I was visiting. He honestly doesn’t remember me being there, but he cried when he read the card. :frowning:

I was a little iffy about my dad marrying someone so much younger than he is (She’s not quite 32… I’m 27. Egads), but after this… I am so grateful for her that I cannot even find the words for it. She honestly loves him sooo much. I sat in the hospital and cried with her over the weekend and she told me that she’s never been this scared in her whole life. That said, she has handled this like a superstar and is such a bright spot in my dads life that I can’t help but love her to pieces. His own brothers haven’t even returned her calls to find out how he is doing. Ugh.

So the big news is that the doctor told her it was their intention to have that goddamn tube out of his throat by this weekend. My fingers have never been crossed so tight. Please god, please let it happen. I miss his voice so much.

13

Just FYI, that does sound like very good news that he’s breathing so much more on his own.

I visited my brother-in-law in the hospital every weekday for a couple months or so, and later he didn’t remember any of my visits during the times he’d been awake, even the time when he first woke up after being brought in, to find his mother and me standing at his bedside. That’s not uncommon at all from what I understand, so I hope your stepmom reassured him on that point too.

Also, realize your dad’s voice won’t be entirely the same after the tube is removed. It’ll be scratchy and somewhat faint, and in my brother-in-law’s case, his voice hasn’t entirely returned to normal.

I’ll be thinking of him and your family.

14

Nothing to say to you but “yay” on Dad’s reduced dependence on the vent and all my very best wishes. Let’s just say that I have seen ARDS up close and I know what you’re up against. Don’t be alarmed that Dad doesn’t remember your visit. If his blood oxygen was as low as you say it was, the fact that he remembers his own name is a wonderful thing. He was bound to be dopey while his blood oxygen was so low.

15

In the US, do they usually wait three weeks before performing a tracheostomy on an intubated patient? Obviously it’s decided on a case-by-case basis, but three weeks with an endotracheal tube creates havoc, from what I’ve understood. Here in sweden they do a tracheostomy if they suspect they’ll be on a ventilator for more than a week.
Malkavia, I’m relieved to hear that he’s on the road to recovery. What an awesome x-mas present!

16

Generally they don’t wait three weeks, although a week is a little more aggressive than what I usually have seen. With the newer ET tubes, tracheomalacia is less of a problem so you can wait a little longer. Although if things look bad at the beginning (especially with PCP and AIDS or with other lung disease), people tend to trach earlier. At least that’s what I learned during my MICU rotation.

ARDS is very serious, it is an organ failure of the lungs. It can have a very protracted recovery and a long, long ICU course followed by months of rehab. Mortality can be as high as 20-40% and long-term damage is not uncommon. Although it sounds like perhaps your father is over the hump and has put most of the danger zone behind him.

The parameters on the vent you want to monitor are probably FiO2 (inspired oxygen percent, the closer to 21% which is atmospheric oxygen content, the better the lung function) and PEEP (positive end expiratory pressure, which is used to stent open airways – CPAP is continuous positive airway pressure so it has PEEP built in), although now that he is on CPAP, that is a good thing – it means his brain and lungs and chest wall are working well enough that the musculoskeletal business of breathing is fine. Since he has been vented so long, they will probably do a slow wean, though, and don’t be surprised that if he starts tiring out, they’ll knock him out again with propofol and put him back on more aggressive ventilation (SIMV or AC or BiLevel or one of those modes).

It will be good for him to be extubated – that’s a wonderful sign and means that he is recovered. But just be aware that this is a serious situation and can change quite quickly. You don’t want to pressure for an extubation and then need to reintubate a few days later, so don’t be discouraged if the doctors want to wait to yank the tube. Also be aware that months of rehab may lay ahead of him. My friend’s mom went in for heart surgery in July, could never get off the vent post-op, developed ARDS, and went through a similar thing. She’s at home now, as of last week, after 1.5 months in the ICU, a few months in step-down, and 2 months at a rehab hospital. But she’s at home, she’s fine, and that’s what is important.

17

Edwino, thanks for the in-depth response. Was just wondering what parameters they went by in the US. I’m well versed on most of the acronyms within a hospital, but MICU? The ICU I get, obviously, haha… but the M? We have a MIVA (IVA being the equivalent of ICU) here in sweden which can be either Medicine or Mobile Intensive care (the former being a unit for intox and non-specific emergency cases). On another note, what are you specializing in? I’m interested in anesthesiology and am planning on pursuing that either on a MD or a RN level. We’ll see which one fits me best.

18

malkavia, I’m so glad that your father seems to be recovering! And I’m glad he has your step-mom to help him along, too. She sounds like a great wife! And it must be quite a comfort to you to know that he has someone caring for him who loves him so much.

19

Thank you all so much for your insight and caring messages. It’s times like this that I totally understand why I’ve been waiting so long for this msg board to load over the past 5 years. (not continuously, but you catch my drift) This place is filled with the most amazing people, really. I will keep you updated on dads progress when I know more.

20

Medical ICU. There is also (two) NICUs (neuro and neonatal), PICU (as in picunurse – peds), NSICU, SICU, CVICU, and several others depending on hospitals. Not to mention LTCs and IMCs (long-term care and intermediate care).

I’m going into Internal Medicine. I’m a fourth year, finishing an MD/PhD, and I’m currently on the interview trail. I spent a month in the ICU in July, with the new interns coming in. It was very, very valuable.