Suggest treatment for ventilator associate pneumonia and fluid in lungs

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Posted on Thu, 11 Jun 2015 in Kidney Conditions
Question: My mother 73 year old gets dialysis 3 times a week and had acquired VAP, ventilator associate peumonia, from staying at ICU( due to cather infection) and now she has been on vent for 6 weeks and has some fluid in lower parts of lungs ,so her cough is not strong enough to remove secretions. She had catheter infection 6 weeks ago and now she still takes Vancomycin and has less fever and TEE was done and it was good.But how can she be off the vent and remove fluid from lungs and so she can breath through trach? Reason for admission was cathter infection and then VAP and now has some fluid in lower parts of lungs and now what. She had acetenobacter in her lungs

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doctor
Answered by Dr. Panagiotis Zografakis 12 minutes later
Brief Answer:
More information is needed

Detailed Answer:
Hello,

first of all I cannot access the link you've provided - I suppose that only you can access it. Can you copy-paste the text or provide an accessible link?

Regarding weaning from mechanical ventilation, it can be tried when the patient is stable. Ventilation with a T-piece is tried for a few hours and the arterial blood gases are checked to see if the patient can cope without the mechanical support.

I don't know the reason that your mother has fluid in her lungs (is it heart failure or infection for example). If her lungs are not in a good shape, discontinuing mechanical ventilation can be difficult.

Acinetobacter is a hard to treat pathogen but I'm sure it has to be sensitive to some antibiotics. The antibiogram gives this information.

If you'd like to provide more information about her case and the course of her disease (like if she's having fever, lab tests, etc), I'll be glad to add more comments.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 44 minutes later
she had catheter infection and light interstial lung disease and she had no CHF and has some diastolic disease due to age . She had no infection 8 weeks ago and hospital report showed her lungs and blood were cleared. Throughout last 6 months, she had no lungs issues. Can we do Bronscopy to remove the fluids in lungs and her cough is not so strong and how can we remove the fluids and make her cough

Copied and pasted my Original Question


My mother 73 year old gets dialysis 3 times a week and had acquired VAP, ventilator associate peumonia, from staying at ICU( due to cather infection) and now she has been on vent for 6 weeks and has some fluid in lower parts of lungs ,so her cough is not strong enough to remove secretions. She had catheter infection 6 weeks ago and now she still takes Vancomycin and has less fever and TEE was done and it was good.But how can she be off the vent and remove fluid from lungs and so she can breath through trach? Reason for admission was cathter infection and then VAP and now has some fluid in lower parts of lungs and now what. She had acetenobacter in her lung
doctor
Answered by Dr. Panagiotis Zografakis 16 minutes later
Brief Answer:
bronchoscopy won't help with the fluid

Detailed Answer:
So the fluid is considered to be be the result of pneumonia or the diastolic dysfunction? If it's the latter then it would be easy to manage. If it's infectious then antibiotics will help. If the fluid is too much for her and causes significant problems to her oxygenation then it can be removed by either aspiration with a needle or by inserting a special catheter and evacuate it over a few days.

Bronchoscopy won't help with the fluid.

For as long as she's connected to mechanical ventilators, she won't be able to cough because she won't be conscious.

Are you sure that the fluid is the only problem that compromises her lung function?
If it's only that another infection is under control then I'm sure your mother has a good chance of getting off the ventilator.

I hope I've addressed your concerns!
Kind regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 13 minutes later
She still has some periodic fever and sometimes it goes away and she still on antibiotics. Fluid in lungs could not be removed by dialysis and what medical procedure can be done to remove fluids in the lower parts of the lungs.

Her secretions can be removed by cough but she cannot cough, note she has cough reflex. And if we take her off the vent , she cannot tolerate no more than 20 mins. how can she be off the vent and be on trach? how we remove the fluid in her lungs that is making dfficult her to cough.
doctor
Answered by Dr. Panagiotis Zografakis 48 minutes later
Brief Answer:
the only way is to fight the infection first

Detailed Answer:
If she cannot stand the T-piece for more than 20 minutes then she cannot get off mechanical ventilation right now. Lung secretions can be partially removed with suction. Lung physiotherapy will also help. The suction can be applied even if she's on mechanical ventilation. The ventilation is interrupted for a while and the suction catheter is inserted as deep as it can get through the trachea.

Fluid in the pleural cavity cannot be removed this way. The only way to remove it is either by dialysis or by inserting a catheter in the cavity.

If the fluid is the only reason that compromises her respiratory function then - provided the infection can be controlled - the fluid has to be removed the way I described.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 35 minutes later
her albumin is low below 2.00 and she has no liver or cns issue and she takes nepho only i think. She uses peg due to trach. How can albumin be increased??
doctor
Answered by Dr. Panagiotis Zografakis 21 minutes later
Brief Answer:
Low albumin usually means serious disease

Detailed Answer:
During the course of a serious illness (very common in ICUs) low albumin is usually caused by liver malfunction. Infusing albumin through a vein won't help. Feeding the patient "by mouth" (Levin tube or gastrostomy) or parenterally may help but sometimes it's not sufficient. Fighting the cause is usually the only permanent solution. When she gets better, her liver would be able to release more albumin and her intestines would be able to work more efficiently (and absorb nutrients).


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 16 hours later
her lungs secretion is causing her using vent thus she is using peg. BUt 2 months ago, she was able to spit and lungs were good. She had cathter infection and then VAP ventiliator associate pneumonia in ICU in a month and half ago. Now she is on vent. How can secretion be normal again like 2 months ago when she was normal. She is also gets dialysis for 1 year and half
doctor
Answered by Dr. Panagiotis Zografakis 28 minutes later
Brief Answer:
She can't get off the vent until the infection is treated

Detailed Answer:
Hi,

I doubt that the secretions alone are the cause of her respiratory failure. A large consolidation in the lung (caused by pneumonia) may induce respiratory failure. If she also has a lot of fluid in the pleural cavity then there is another reason for it. But the way you're describing it, I can't be certain about her real condition. You talked about fluid in the lungs which refers to fluid in the pleural cavity, then about secretions which refers to fluid inside the airways (by the infection). Perhaps you could upload a radiological report (X-ray or CT-scan).

Anyway, the airway secretions can be removed by suction and perhaps even washed out with bronchoscopy (if they are so many and can't be handled otherwise). For the most cases, physiotherapy and suctioning is enough, if the antibiotics do their job. Fighting the infection is the right way, as I've already pointed out. When the infection gets under control, she'll have a chance to get rid of the vent.

I just want to add one more thing here, because I forgot to comment on it, in my previous answers. Patients in the ICU that need the Prisma (renal replacement therapy), may not have fever even if they're seriously ill.

Finally I can't say whether she can get out of it and be "normal" again. It depends on the extent of the damage that the infection has caused to her.

I hope I've clarified some issues to you!

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 25 minutes later
spoke to docs told me her saturation is weak and not able to remove secretions.
She is on lower end of vent rate (28) and pnemonia is gone and blood is cleann.

Fluid is removed by dialysis and secretion is there; why is secretion there and how can secretion be normalized, so she can be on trach??
doctor
Answered by Dr. Panagiotis Zografakis 21 minutes later
Brief Answer:
The answer has been given

Detailed Answer:
I understand your concern but you keep asking about the secretions like if I haven't answered! I repeat the way to clear the secretions and prevent the formation of new ones:
- fight the infection: there can be secretions even without infection but they can't be that many! No infection, no real problem with the secretions.
- physiotherapy: percussion, postural drainage, suction, etc
- as soon as the above have been adequately completed, getting off the vent is the most helpful step.

You've mentioned that her heart is functioning fairly well and her lungs are clear. If both of these assumptions are correct then she has to be able to get off the vent soon.

If she gets rid of the vent and she's conscious and not aspirating food, liquids, secretions etc, she's not supposed to have any more secretions.

Best wishes for her recovery!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 14 minutes later
edit
blood is clean but i will send you ct scan of her lungs
doctor
Answered by Dr. Panagiotis Zografakis 46 minutes later
Brief Answer:
OK

Detailed Answer:
The CT scan would be very helpful!
Please do.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3680 Questions

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