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TRY TO TAKE SPUTUM FOR GRAM STAIN AND CULTURE WITH THAT REPORT SENSITIVE ANTIBIOTIC CAN BE GIVEN TO CURE PNEUMONIA AND SEPSIS

More details needed and you can try consulting in apollo indraprastha. I am not saying doctors seeing your case are not good or anything but there is nothing bad in taking 2nd opinion

Thank you for your query Being an Critical care specialist I understand criticality of patient but it’s not clear from your msg that weather it is just sepsis or septic shock Since he is on tracheostomy ,Suction is standard care for tracheostomy Current line of treatment must be on the basis of Culture and I am sure he is getting that in Max Since you have not posted current on going treatment and culture reports so it’s difficult to comment on this part Prediction of prognosis depends upon several parameter so that also not possible to comment but yes I can say that with right treatment recovery is very much possible

Hello, Thank you for sharing the detailed history. This is a critical illness scenario involving severe pneumonia with sepsis and a multidrug-resistant organism (Acinetobacter baumannii), requiring intensive care support. 1️⃣ Current line of management (appropriate) ICU care with tracheostomy support Culture-guided targeted antibiotics Adequate suctioning and airway care Nutritional support via NG feeding Monitoring for organ dysfunction (kidney, liver, lungs) 👉 From your description, the ongoing management appears in line with standard ICU protocols. 2️⃣ Possible considerations / changes Ensure antibiotics are strictly based on sensitivity report (MDR infections may need drugs like Colistin / combination therapy) Evaluate for source control (persistent infection focus, ventilator-associated pneumonia) Regular reassessment for: Sepsis control Fluid balance Secondary infections Chest physiotherapy & gradual weaning trials when stable 3️⃣ Prognosis Recovery in such cases is slow and variable MDR infections + age (65 yrs) → prognosis is guarded Improvement, if it occurs, usually takes weeks rather than days 👉 Positive signs to look for: Reduced oxygen / suction requirement Improving infection markers Better sensorium / spontaneous breathing 📌 Important note At this stage, continuing ICU care in a well-equipped center is crucial. Close coordination with the treating intensivist team is essential, as they have real-time clinical data. Conclusion: The current treatment approach seems appropriate. Focus should be on targeted antibiotics, supportive ICU care, and gradual recovery monitoring. Prognosis is guarded but not hopeless—patience and continuous care are key.

Hello, I am Dr. Romain Rajan, General Physician (Ex Govt Medical Officer at RML Hospital, New Delhi), and your case has been allotted to me. Thank you for sharing the details. I understand how stressful this situation is for the family. I will explain this clearly and honestly. Understanding the current situation From your description: • 65 year old male • Severe pneumonia with sepsis • On tracheostomy support • Multidrug resistant Acinetobacter infection • Dependent on suction and NG feeding 👉 This indicates a critical and complicated ICU case, but not without hope. Current line of management (what is usually correct) In such cases, standard management includes: • Culture guided high end antibiotics (like colistin, polymyxin, tigecycline etc.) • Strict ICU care with infection control • Respiratory support and suctioning • Nutritional support via NG tube • Prevention of secondary infections 👉 If this is being followed, treatment is on the right track Possible changes / what to discuss with treating team You can ask the ICU team about: • Latest culture sensitivity report → Are antibiotics fully targeted to Acinetobacter? • Whether combination therapy is being used • Procalcitonin / CRP trends → Is infection improving? • Chest imaging progress • Possibility of: – Superadded infection – Fungal infection (important in long ICU stay) • Early physiotherapy and chest rehabilitation Important clinical challenges in this case • MDR organism → limited antibiotic options • Age 65 → slower recovery • Tracheostomy → indicates prolonged respiratory failure • Swallowing difficulty → risk of aspiration Prognosis (honest and balanced) 👉 Recovery is possible but slow and uncertain Depends on: • Response to antibiotics • Organ function (lungs, kidneys) • Nutrition and rehabilitation • Absence of further complications 👉 Such patients often take: • Weeks to months for recovery • Gradual weaning from tracheostomy Signs of improvement to look for • Reduced need for suction • Improving oxygen requirement • Decreasing infection markers • Better alertness and response Important reassurance You are already in a tertiary care hospital, which is appropriate. These cases are difficult but not hopeless, especially if infection starts responding. What you should do now • Stay in regular discussion with ICU team • Ask for daily progress in simple terms • Ensure nutrition and physiotherapy are optimized For a detailed second opinion, report review, and step by step guidance, you can reach out to me directly on WhatsApp at 85271646 seven seven. I can help you understand reports and decisions in real time. Wishing strength to you and recovery for the patient. Dr. Romain Rajan General Physician

Continuing the same..with ng feed and suction..fluid and electrolyte balance shud be maintained..urine output input..kidney status...bre ure lft rft..reports needed..pt shud be on oxygen support..xray chest..ct chest needed to rule out any abnormality..neurological status shud be monitored..hiv hbsag vdrl shud also be checked...cd4 count..pcr test too..to rule out viral disease..neurological and ear diseases shud be ruled out..cause of bulbar palsy...ct brain to rule out abscess or infection..tb shud also be ruled out...tb spine..rule out gi ulcers or bleeds...

A patient who has a tracheostomy and is on intermittent ventilatory support is not a candidate for Tele-consultation. Your aim of Tele-consultation is not for the betterment of the patient, but only to put the treating Doctor on the backfoot. Please let those Doctors work in peace.

Ask for repeat culture, ask, them for antibiotics like metronidazole for anaerobic germs,  which do not come in routine  cultures. His  condition is very critical, but you can keep hope as sometimes things do change at last moment for better..

Need more details. I am critical care specialist. Consult and send reports for further management including ventilator settings and cultures

From ur history, pt condition is quite sick, u can ask for repeat cultures and can give antibioitcs according to it. Usually sepsis and pneumonia takes time. Prognosis is poor. But u are already getting best treatment. Praying for his/her better health.

In hospitalized patient  they do there  best. No  interventions  apriciable  by hospital authority.

It will take time to recover ,continue with medicines.

I’m really sorry your family is going through this. In such complex ICU cases, detailed review of reports and current treatment is very important before advising further. You can book a consultation and I’ll guide you step by step.

I'm sure this must be hard for you. Given the information you have shared , the current situation is concerning. Things that are not in his favour: The primary diagnosis itself of Pneumonia with sepsis, further complicated by being Drug resistant. The situation becomes more complex if there are Co- morbidities as well( Diabetes, Hypertension, Lipids issue, cardiac issue etc).

Do consult

Continue the treatment for recovery.

Continue the treatment. Multiresistant infection takes time to settled. Be admitted and continue proper treatment.

Current line of management should focus on: Culture-directed antibiotics (most important) For MDR Acinetobacter, treatment must be based on sensitivity report—not empirical escalation. Depending on susceptibility, options may include ampicillin-sulbactam, carbapenems (if susceptible), or polymyxins like colistin/polymyxin B, sometimes with inhaled colistin in pneumonia cases. Source control Repeat cultures (tracheal aspirate/BAL, blood, urine if needed) Rule out: line infection lung abscess empyema secondary fungal infection Respiratory rehab Aggressive chest physiotherapy Nebulisation Suction protocol Humidification Gradual trach weaning assessment Nutrition High-protein feeding Correct albumin/electrolytes Glycemic control Neuro/swallow evaluation Dysphagia after prolonged intubation/trach is common Speech/swallow therapy can help 2) Possible changes in treatment If “no significant improvement”: Recheck antibiotic sensitivity report Check whether organism is colonization vs active infection CT chest if not already done Evaluate for: ARDS/fibrosis recurrent aspiration occult infection focus Infectious disease + Pulmonary/Critical Care opinion together 3) Prognosis Guarded—but not hopeless. Recovery depends on: Good signs Off ventilator / only trach support Stable BP without vasopressors Improving oxygen need Kidney/liver okay Conscious/cooperative Poor prognostic signs Persistent fever/sepsis Shock Renal failure Rising inflammatory markers Repeat cultures still positive Muscle wasting / bed bound state Many such patients recover slowly over weeks to months, especially respiratory and swallowing function. If you can share: culture sensitivity report, current antibiotics, oxygen requirement, kidney function/creatinine, whether patient is conscious and moving limbs

Such things cannot be discussed merely on the basis of these 6 lines. Need whole file, reports, current ongoing treatment, parameters and so on....

Need a few more details please consult for further evaluation and treatment

Kindly do connect and consult

Need few more details. Kindly consult for further evaluation

Guarded prognosis

Can help you, kindly consult and provide detailed history for proper diagnosis and further management

Doctors who have clinically examined patient are best

Since the diagnosis is multi drug resistant pneumonia, it is adviced to either get sputum culture for all including AFB or start with broad-spectrum antibiotics like Meropenem/ vancomycin or the most rarely used chloramphenicol or septran in optimum doses. Change the NG as that could be there added source of infection. Take care that NG is flushed after every feed. Get a CT chest to rule out associated pleural effusion and manage that accordingly. Hope the cardiac status is being checked regularly too.