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Hello Doctor,
We would like to consult you regarding this critical case. The patient (65-year-old male) is currently admitted at Max Hospital, Dehradun, and is on tracheostomy support following severe pneumonia with sepsis.
Despite ongoing treatment, there has been no significant improvement. The reports also indicate a multidrug-resistant infection (Acinetobacter), and the patient is still dependent on suction and NG feeding due to swallowing difficulty.
- Current line of management
- Possible changes in treatment
- Prognosis and expected recovery
We would really appreciate your expert opinion and assurance on how to proceed further.
Thank you.
Answers (27)
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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
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Kindly do connect and consult
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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
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Guarded prognosis
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Can help you, kindly consult and provide detailed history for proper diagnosis and further management
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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
Next Steps
Just Trust your physician
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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.
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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
ð 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
ð 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
â Are antibiotics fully targeted to Acinetobacter?
⢠Whether combination therapy is being used
⢠Procalcitonin / CRP trends
â Is infection improving?
⢠Chest imaging progress
⢠Possibility of:
â Superadded infection
â Fungal infection (important in long ICU stay)
⢠Early physiotherapy and chest rehabilitation
Important clinical challenges in this case
⢠MDR organism â limited antibiotic options
⢠Age 65 â slower recovery
⢠Tracheostomy â indicates prolonged respiratory failure
⢠Swallowing difficulty â risk of aspiration
Prognosis (honest and balanced)
ð Recovery is possible but slow and uncertain
Depends on:
⢠Response to antibiotics
⢠Organ function (lungs, kidneys)
⢠Nutrition and rehabilitation
⢠Absence of further complications
ð 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
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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...
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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.
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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..
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Need more details. I am critical care specialist. Consult and send reports for further management including ventilator settings and cultures
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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.
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In hospitalized patient they do there best. No interventions apriciable by hospital authority.
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It will take time to recover ,continue with medicines.
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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.
Next Steps
Culture sensitivity of the sputum for all+ AFB
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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.
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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).
Next Steps
Please don't move him away from the hospital just yet. Depending on the response of the Antibiotics/ antifungals/steroids being administered,repeated cultures may help narrow down the right combination of medicines.
However, prolonged illnesses and hospital stay in itself is a source of added and acquired hospital infections. These may become hard to tackle
Health Tips
It seems like a testing time, but it also comes across that what's needed to be done is being done. Requesting your treating doctor to share the plan with regards to his treatment, his response to it and clarity to things looking hard or promising will help you take informed decisions.
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Do consult
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Continue the treatment for recovery.
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Continue the treatment. Multiresistant infection takes time to settled. Be admitted and continue proper treatment.
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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
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Such things cannot be discussed merely on the basis of these 6 lines. Need whole file, reports, current ongoing treatment, parameters and so on....
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Dr. Vetsa Sri Krishna Chaitanya
General Physician
7 yrs exp
Rajahmundry
Need a few more details please consult for further evaluation and treatment
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Dr. Ashita Kuruvilla
General Practitioner
8 yrs exp
Kolkata
Need few more details. Kindly consult for further evaluation
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Dr. Chaithra H
General Physician
5 yrs exp
Bangalore
Doctors who have clinically examined patient are best
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