We are looking for guidance/opinions regarding next steps for our 82-year-old grandmother who is currently in ICU on ventilator support. We understand nobody can give medical advice online, but we are trying to understand what questions we should be asking and whether continuing aggressive treatment makes sense versus focusing on conservative/palliative management.
Summary of her condition:
- 82F with known CKD, diabetes, hypertension
- Developed severe shortness of breath, swelling (anasarca), and very low urine output
- Diagnosed with:
- Lower respiratory tract infection
- Type 2 respiratory failure
- AKI on CKD with anuria
- Severe fluid overload
- Anemia and electrolyte imbalance
- Cardiac dysfunction (LVEF 40–45%)
- She was intubated and transferred to ICU
- Has required repeated SLED/dialysis sessions
- Blood culture positive for staph bacteria
- CT chest showed bilateral pleural effusion and cardiomegaly
- Failed spontaneous breathing trials multiple times
- Doctors advised tracheostomy due to prolonged ventilation, but family has not consented yet
- Bronchoscopy/BAL also being planned
- Prognosis has been explained as “guarded”
Current status:
- Still ventilator dependent
- On antibiotics, dialysis support, TPN, and ICU care
- Some neurological improvement noted (better GCS than admission)
- BP supported with norad
- Oxygen requirement currently not very high
Main questions we are struggling with:
- In elderly ICU patients with this many organ systems involved, what outcomes are realistically seen after tracheostomy and prolonged ventilation?
- Does tracheostomy usually improve comfort/recovery chances meaningfully, or mostly prolong ICU stay?
- How should families decide between continuing invasive procedures vs conservative/palliative management?
- What specific prognosis questions should we ask the ICU team?
- If dialysis and ventilator dependence continue, what quality of life outcomes are common in patients of this age?
- Would seeking a palliative care consult at this stage be appropriate even if treatment is ongoing?
We are not looking for false hope or negativity — just honest perspectives from ICU doctors, nephrologists, pulmonologists, or families who have gone through similar situations.
Note : Attached image is created from acutal case summary using AI , actual names and other PII info are removed.
u/Glum_Course9256 — 14 days ago