#lvad

We Have A Spartan

February 9-12, 2017

As usual, Den went to the infusion center for his IV therapy every day and to Cardiac Rehab 3 times a week. Otherwise, no problems came up and life went on as usual.

  February 13, 2017

Today, Den has his blood draw and dressing change before his IV therapy starts.

The lab results almost always come back before his session is completed and today is no exception. His INR is…

Hey there nonny! Thanks for this question. Let’s dive in! 

“Life support” is an extremely nebulous term. For example, the term “basic life support” is a fancy way of saying CPR and rescue breathing, while “advanced cardiac life support” is a nice way of saying “extreme cardiac event resuscitation with tubes, IVs, and drugs.” 

Both of those are real-life American Heart Association classes. 

But I have a sneaking suspicion that what you mean by “life support” is closer to “life-saving care in the ICU.” 

That still comes in a great many different forms. “Life support” is the term for the whole care package, the sum totality of all things that are directly assisting to keep the person alive. That might include -- 

feeding systems via nasogastric (NG) tubes

IV drips of life-saving medications, including sedatives if they’re intubated, and those that increase blood pressure such as norepinephrine

a breathing tube and a ventilator 

a cardiac assistive device, such as a balloon pump (which is a pump connected to a balloon in the aorta), an LVAD (Left Ventricular Assist Device) or BiVAD (BiVentricular VAD) which are pumps in one or both ventricles, an Impella device (similar to a VAD but different technology), Berlin heart (a type of VAD) 

ECMO (Extracorporeal membrane oxygenation), aka “pulmonary bypass”; this is a set of enormous IV tubing that hooks up to a big external filter where the blood is allowed to exchange carbon dioxide for oxygen

The character’s “life support” is entirely dependent on what’s wrong and what they need. 

I would say the most common thing people mean when they say “life support” is a ventilator, because it’s extremely common and it takes over a natural and basic function -- breathing. 

As for a character coming off the ventilator, this is also an extremely common occurrence! The point of a ventilator is, in most cases, a temporary way to help the lungs oxygenate (with pressure support), and a way to reduce the workload of breathing (which can help other parts of the body). Characters may also be intubated for “airway protection,” meaning that they have a high risk of vomiting and not being able to clear it on their own. 

Coming off the ventilator is a decision made by the doctors about the character’s health. They’ve decided that the character can breathe effectively on their own, or that they at least want to see whether or not they can. 

So they disconnect the vent, deflate the balloon at the end of the tube, have the character take a deep breath, and, as they exhale, they’ll pull the tube out of the throat. They may suggest that the character cough while it’s being removed as well. 

If all goes well the character won’t need any kind of respiratory support, but if they need something, there are a lot of ways to help. Oxygen via a cannula (the little plastic bits you see in noses on TV all the time) helps a little bit, but if they need some pressure support without a vent, a face mask known as CPAP or BiPAP can get the job done. (More recently, high-flow nasal cannula, or HFNC, is coming into style as a way to give pressure support without obstructing the character’s mouth, so that they can eat and speak effectively. HFNC is usually very well tolerated.

After Effects 

You asked about physical and cognitive effects of coming off of “life support.” 

This is kind of hard to say. That’s because a large number of ICU patients wind up with delirium in the ICU and may develop post-traumatic stress even after leaving. ICUs are hard places to be: medications mess with your energy levels and sedation can really cause disorientation and possibly even hallucinations, physically, the character can’t move much; there are constant alarms  everywhere to the point that I don’t know how ICU nurses survive without going bonkers. 

Then there’s the fact that sometimes characters in the ICU are restrained, particularly if they have a breathing tube in and they try to pull it out. Imagine being in pain, unable to speak, and unable to move or request help. That’s a big deal from a psychological perspective. 

Physically, intubation can be traumatic. Vocal cords can be damaged by the tube, leading to difficulty speaking, a raspy voice, etc. Also, artificial ventilation can cause some damage to the lungs, which can cause decreased ability to breathe after the fact, and may require pulmonary rehab. (This is less common than it used to be.) 

IVs can cause bruising and pain. Norepinephrine in particular can cause necrosis of tissue further down the limb, which is why it’s usually given through a central line, a big IV in the groin, clavicle, or neck. Cardiac assist devices, like LVAD/BiVAD, are almost always permanent. Devices like balloon pumps, which are temporary, still leave whopping big holes in the groin and can cause toes down the leg to die due to obstructed blood flow. 

And none of this even talks about why the person was in the ICU to begin with. 

Some characters will get better, leave the ICU, and lead healthy normal lives again. Some will have permanent reminders of what it was that brought them there and how they felt in the unit. And some -- too many -- will die on the unit. 

I hope this helped! 

xoxo, Aunt Scripty

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