A man (84) was admitted in the ICU 30 days ago and still unconscious. Any advice?
An 84 years old man was admitted in the ICU 30 days ago with aspiration pneummonitis , shortness of breath and disturbed level of consciousness . His Galasgo Coma scale was 8 . Renal functions were impaired with elevated both serum urea nitrogen and serum createnin. He was heavy smoker with COPD He was hypertensive on tenormin 25 mg daily . He also had transient Ischemic attack twice and wS on clopex daily In the ICU , they inserted nasogastric tube NGT for feeding and endotracheal tube Another attack of aspiration occured and tracheo-osophageal fistula was diagnosed so the feeding stoped through the NGT and the endotracheal tube was replaced with tracheostomy Now his on a mechanical ventilator and a lot of secretions pn the chest He is beeing suctioned frequently with bloody discharge and sometimes blood clots blocks the suction tube His INR was high and the antiplatelet treatment was discontinued and fresh frozen plasma was given to him to correct it with temporary improvement His blood pressure became low and on adrenalin for support His heart was in arrest once and was resuscetated He is recieving antibiotics He has hypoalbuminemia and developed generalized oedema and his GCS decreased to about 3 He recieved mannitol When he was admitted he had metabolic acidosis which is now near normal
What was dad's health like bedore this episode? Is the aspiration something that resulted from advancing dementia? Or was he hale and hearty before this? Do you have explicit instructions from your dad's medical directive about what to do if he's in this sort of situation?
Anything I say beyond this will be seen as unkind and possibly insensitive.
If this was my loved one I would stop all life saving treatment and consult with hospice. Although miracles do occur from your description death for your father is very close and how you handle this is naturally your decision based on medical advice. It is very easy to judge others based on a very small amount of information from a new poster. Most people here will be very supportive of whatever decisions you make. There may be valid reasons for trying everything to keep your father alive at least for a short time but whatever is tried eventually nature will take it's course.
My Dad had aspiration pneumonia, and after a few days in the hospital and a series of swallowing testing, it was decided he was a candidate for Hospice care. At his age [95], there wasn't any magic cure for whenever he tried to eat or drink, the food/water would go into his lungs.
My Dad had what is called a Living Will, where he expressed his wishes for no feeding tubes, what he would allow and not allow. I wanted to honor his wishes as per the Living Will. He passed peacefully a few days later.
I have a feeling that your Dad didn't have a Living Will, so you are trying everything you can to keep Dad alive. That is understandable. But what will be his outcome and quality of live? Sorry you are in such a difficult decision situation.
Is there a question?