23rd time’s a charm

No..not as in hospitalizations ( I’ve lost count of those,) I’m talking about my 23rd endotracheal intubation with mechanical ventilation for respiratory failure. You heard that right, Ive been intubated 23 times now! (as of 5-23-2018, make that 42 times). That’s gotta be some kind of weird worlds record or something. How is this even possible ? Once, maybe twice… but not dozens of times? This just doesn’t happen. Granted, most of these intubations have been relatively brief, but some of these have lasted as long as 8 days.

Making this number even more astonishing, is that the decision to intubate a person with asthma is never taken lightly. Asthmatics are at risk for severe decompensation during intubation,and because mechanical ventilation doesn’t directly help with expiration(which is the primary problem in a patient with status asthmaticus). Also, placing a tight asthmatic on a ventilator can be fraught with potential complications, including pneumonias, pneumothorax, Hemodynamic instability, etc.

Often times, people who’ve had multiple intubations and/or spend prolonged periods of time on a ventilator, end up with a tracheostomy. How is it that Ive managed to avoid a hole in my neck?

How is it that Ive managed to beat the odds for so long? Is it just luck? Is it early intervention? Is it because I’m an RT? Is it because I have easy access to emergency and specialized medical care?
I would say it’s probably all the above, with the access to medical care being the most important. Regardless of how severe a persons asthma is, or how sick they might get during a flare, if they can get to a hospital in time, they should be able to survive the attack. It’s usually those individuals who symptoms come on suddenly and massively and who dont receive resuscitative treatment soon enough, or who don’t have the proper medications who die from the disease.
Whatever the reason for my longevity, I’m certainly grateful. But seriously, this nonsense has got to stop. Every time I end up on ventilator, it ends up taking me twice as long to recover, and even then I never fully get back to normal.

Finally, while my 23rd intubation happened because of respiratory failure, asthma is not the primary reason I went to the hospital in the first place. I went to the hospital because of a fever.

Here’s the back story that led up to #23.

About 4 weeks ago I had a moderate asthma flare and ended up in the hospital. I was pretty sick and spent a couple days in the ICU, but I wouldn’t considered myself “critically” ill. I responded really well to the IV steroids and bipap and was discharged from the hospital only 5 days later. The recovery from that admission went fairly smooth and by the 9th day out of the hospital I was about 90% back to my baseline.

Then on the afternoon of the 10th day, I suddenly developed some really severe chills. And when I say suddenly, I mean like out of the blue suddenly! One minute I’m feeling fine, the next Im shaking with severe rigors.
I had had several medical and dental appointments earlier that week, so at first I thought maybe I picked up a bug in one of those places. I don’t know, but the chills were getting worse by the minute, so I thought Id better check my temperature. When I finally checked it was almost 105 F (104.8). I thought, what the heck is going on? I wasn’t having any major breathing issues at the time, I just felt super hot and had really bad chills. I took some Motrin and hour later my temp dropped to 103.5 I still felt horrible and since I had only been out of the hospital for 9 days I figured it probably wise to have the fever checked out. Not wanting to go the ER for fear of being admitted, my partner left work early and took me to the local Urgent care center. Upon arriving there my temp had apparently spiked again, and not knowing what they were dealing with, they thought it would be better for me to go directly to the Emergency Room. Reluctantly I agreed, but thank goodness I did, because 12 hours later I ended up on a ventilator.

Mind you, the first couple hours in the ER my asthma symptoms were still minimal. I was there because of the fever, not my asthma. They took blood cultures and worked me up for the fever assuming it was an pneumonia. It wasn’t until much later that evening when I could tell my asthma was getting worse. It was at that point where the concern changed to my breathing, so they started me on the standard asthma protocol of cont nebs, steroids and eventually bipap before moving me to the ICU. As the night progressed my breathing took a turn for the worse. It was getting more and more difficult to breath and my ABGs were getting worse. It was right after my 4th blood gas that I remember the Pulmonologist saying, you’re gases are getting worse, we need to intubate you. For the next 4 and a half days I remained in an induced coma on the ventilator.

They let me wake up for a few hours the day after being put on the ventilator. I remember visiting with Douglas and my breathing being a lot easier, but for some reason they decided to knock me out again and they didnt wake me up for another 3 days. When I eventually did come to, they we’re already weaning me off the ventilator. For some reason ( probably all the medications) I was not happy. I woke up really agitated and short of breath. I remember the ICU nurse threatening to put me in wrist restraints if I didn’t calm down. I also remember flipping off a camera mounted in the ceiling of the ICU room, that I felt was too intrusive. Eventually they calmed me down and an hour later I was extubated without incident.

I’ll spare you the details of the rest of this hospital stay, as it was pretty much the same as previous. After being extubated, my fevers went away and my breathing gradually improved. I was discharged from the hospital after 8 days.

They never found the source of the fever. My chest xray showed some atelectasis , but no consolidation, so at the time there was no pneumonia. It’s anyone’s guess, but it was probably a virus I picked up some where, possibly from the previous hospitalization. Like most sick asthmatics, I was on a lot steroids at the time, which can lower your immunity. The fever or maybe the chills were the trigger for the asthma flare, but what the heck caused the trigger?

UPDATE( 7/16/2015): One week out of the hospital and I started having fevers again. On 7/7/2015 I was readmitted to the hospital for another 4 day and worked up for FUO ( fever of unknown origin). After being CT scanned from head to toe and having tons of blood work done, still no answers. All the tests came back negative. They now believe that my VAP might be infected, so next week they’re going to see about having it removed. If the fevers continue, that will be a whole new story. Let’s hope not. It’s bad enough having really severe asthma, having fevers on top it is no fun.