COPD

[joyfulwoman]

Hi all,

This is my first post and I am glad to have found these boards.
I am on the west coast and my dad is in the east. He has copd and asthma Last he was admitted to the hospital. He is in the ICU due to his copd He also has the flu, pneumonia from the ventilator and the nurse said asthmatic lungs. At one point they said his carbon dioxide levels were way too high. He still has a fever and they tell me that he is not in immenant danger, but basically if he wasn't on the ventilator...it would not be good. My aunt told me that they said they don't want to keep him on the ventilator for more than 14 days and that they will do a tracheotomy. Also, he was on the chemical paralytic and is totally sedated...he is out.
I guess I am just trying to put all these bits and pieces of information together. The nurses were very candid, and I appreciate it. They told me that time wise he for sure will be there at least two to three weeks, but that he is critical, he is in the ICU afterall and those lungs need to improve.
What do these things mean and is this as severe as I am thinking?? Thank you for your replies.

[Davy9]

What many do not understand about COPD is that it has a very high cost of breathing. Breathing for them is a lot of work because of the anatomical changes in their chest and the physiological changes in their lungs. When they get any acute lung disease (like pneumonia) their breathing is additionally taxed, they tire quickly and often end up requiring mechanical ventilator support. Once on the ventilator they get 100% relief from this heavy workload and, whether they understand it or not, they feel relieved. Then as the ventilator is slowly weaned away that have a hard time accepting their high breathing workload back. The longer the ventilator course, the harder it becomes to wean them for many different reasons.

Not knowing the particulars about your father I cannot venture to say how dire his predicament is. He has suffered from respiratory failure (evidenced form the high CO2 level) requiring mechanical support. He does have reactive airways in the form of asthma which is in addition to his COPD. You also say he has a hospital acquired pneumonia from being on the vent. This is not uncommon, but it also not necessary. The hospital could have done better. You need to learn how much his heart is affected from his COPD. If his heart, kidneys and liver are all working somewhat normal he could get well enough to wean. If his COPD is not too advanced he may wean easy. If not, his weaning could become protracted and the longer he's on the vent to more he's exposed to problems like the pneumonia, etc. COPD is a rough road. Good luck to you both.

[joyfulwoman]

Thank you so much for your post. I've been checking back to these boards all morning and it is nice to be able to talk (somewhat) to somebody about this. I will make sure I ask about his vitals and what you had mentioned. I do know that one of the nurses at one point said that I guess more towards the beginning when they tried a bit to wean off the sedation, the blood pressure was waaay too high. I mentioned it to the next nurse and she basically said, we aren't even close to bringing him up, so that is not an issue at all now, because the lungs are still needing to improve.
It is so hard, because I call to get the update and my family gives me an update, but they have a crisis they are dealing with so I check with his nurses on my own to relieve them of having to worry about telling me things.
Davy9, thank you again...oh, do you know from your experience, what exactly does the tracheotomy signify? I know you can't give me specific medical advice, I am just wondering if anybody has similiar experiences.

Take Care

[Davy9]

When anyone is placed on a mechanical ventilator an airway must be placed in the trachea to secure a patent pathway to attach the patient to the machinery. For short term purposes this is done using an endotracheal tube that passes through the mouth or the nose down into the main airway (the trachea). This down whenever general anesthesia is used. Anyway, that is good for short term, a few weeks at best. Then they go ahead and cut a hole in the neck, below the adams apple and place a tube directly into the airway through the stoma (the opening). This is a lot more comfortable for the patient and it has fewer potential complications that a long term ET tube, but it is not without potential complications. Sometimes the tracheotomy is done sooner or even immediately if there's problems with accessing the airway from above or the case is clearly a long term scenario.

[joyfulwoman]

I was having trouble with posting on this, but I think I figured it out. Anyway, as a way to continue this post I started a new thread called airway pressures high? I guess I will just look for any responses there. Thank you for any replies.