Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we instantly improve the lives of Families of critically ill Patients in Intensive Care, so that you can have real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from one of our readers and the question that I answered was
You can check it out here.
In this week’s episode of “YOUR QUESTIONS ANSWERED”, I answer another question that many of our readers want to know about, if their loved one is critically ill in Intensive Care and in this week I want to answer
”HOW LONG CAN SOMEONE STAY IN AN INDUCED COMA?”
All of those interventions, mechanical ventilation, the breathing tube(endotracheal tube) and the induced coma are interventions that are very scary for your critically ill loved one as well as for you and for your Family.
When you first see your critically ill loved one in this situation where they require a ventilator, a breathing tube and they are in an induced coma you may feel shocked or unpleasantly surprised when you first see how unfamiliar your critically ill loved one looks.
It’s even worse if your critically ill loved one requires a ventilator, the breathing tube and the induced coma if they had an accident and they may have bandages and dressings around their arms, legs or head. They may also have blood in their face and on other body parts. It’s not a pleasant look and feel for you and your Family.
Why is the induced coma required?
But first of all, let’s quickly look at why your critically ill loved one needs to be in an induced coma.
Whenever a critically ill Patient gets admitted to Intensive Care and requires mechanical ventilation on a ventilator or respirator, a breathing tube(endotracheal tube) and the induced coma is also required in order to establish a secure airway. Your critically ill loved one needed the ventilator/ respirator and the breathing tube because they either couldn’t maintain a safe airway or they stopped breathing altogether because of the critical situation they have been in.
Another scenario or situation that can lead to mechanical ventilation, the breathing tube(endotracheal tube) and the induced coma is that your critically ill loved one required surgery, they were therefore induced into a coma in the operating theatre and depending on the length of the procedure, complications such as bleeding and/or haemodynamic and/or respiratory(breathing) issues they now require Intensive Care for mechanical ventilation, the breathing tube(endotracheal tube) and the induced coma as a safety and/or prophylactic measure.
As a rule of thumb, whenever a critically ill Patient requires mechanical ventilation and a breathing tube(endotracheal tube) they automatically will need to be in an induced coma. The reason for the induced coma is that your critically ill loved one wouldn’t be able to tolerate a breathing tube in their throat whilst being attached to a ventilator/ respirator. The breathing tube as well as the positive pressure and the volume that gets delivered into the lungs would be very uncomfortable to be tolerated without a medically induced coma.
On the other hand a medically induced coma would be contraindicated without a ventilator and a breathing tube, because critical, vital and important life saving functions would be compromised and put Patients into a life threatening situation.
The other reason and also advantage for your critically ill loved one when being induced into a coma whilst being critically ill is that critical and vital body functions can be monitored and managed. Many of those vital body functions such as heart rate, heart rhythm, blood pressure, body temperature, brain function and sometimes brain pressures, kidney function, liver function and other body functions as well can recover during an induced coma whilst your critically ill loved one is “put to sleep” so to speak.
The following admission scenarios to Intensive Care most often lead to a medically induced coma and ventilation
- Open heart surgery
- Sepsis(globalised severe infection often resulting in multi-organ failure)
- Severe head or brain injuries
- Heart attack
- Heart failure
- Cardiac arrest
- Abdominal Aneurysm repair
- ARDS or lung failure
- Drug overdose
- Guillan- Barre syndrome
- Liver failure
- Liver transplant
- Heart transplant
- Lung transplant
What is required for the induced coma?
In order for your critically ill loved one to be induced into a coma, sedative and opiate drugs are required such as
- Propofol(Diprovan), which is a short acting sedative drug and is commonly used for an induced coma <72 hours
- Midazolam(Hypnovel/ Dormicum), which is a Benzodiazepine and is more commonly used for long term sedation> 72 hours
- Morphine, a strong pain killer and opiate
- Fentanyl, a strong pain killer and opiate
Those drugs are all given intravenously and they should be administered via a central venous line(CVC)
Given that Midazolam is a Benzodiazepine it should be used sparingly, as it can have a tendency to accumulate in the body system and “waking up” after the induced coma maybe prolonged and delayed because the Midazolam is still in the body system even after it has been ceased and it can also make people addicted.
The same applies to Morphine and Fentanyl, the longer those drugs are being used the bigger the risk that they accumulate in the body system as well, “waking up” can get delayed and it can also make people get addicted to those drugs.
Therefore the longer your critically ill loved one stays in an induced coma the higher the risk to go through a withdrawal when waking up out of the induced coma. This is also sometimes the reason why your critically ill loved one may be confused, agitated and non- cooperative at times.
Propofol is a good choice for sedation as it’s short acting and it does have a tendency to let critically ill Patients “wake up” quickly after Propofol has been ceased.
How long can my critically ill loved one stay in an induced coma?
The answer is that it depends. In theory an induced coma can go on for long periods of time, sometimes many weeks, as Michael Schuhmacher the famous formula one racing car driver and former world championship has shown. He was in an induced coma for nearly two months, before he was “woken up”, not without any difficulties.
In most cases, especially when critically ill Patients have been in a coma for more than 3-7 days, “waking up” can be difficult and not linear. It’s often like switching on a light with a “dimmer” and it can be a slow and gradual process.
As I have hinted towards, your critically ill loved one may get confused, agitated and sometimes non- compliant as well. The reason for being confused, agitated and/or being non-compliant is often the side effects from the drugs given during the induced coma.
As a rule of thumb, the length of time where your critically ill loved one stays in an induced coma should be minimized as much as possible. However, depending on the circumstances, sometimes a prolonged induced coma is necessary and may well be in the best interest of your critically ill loved one especially if they are clinically unstable. Especially if they have low blood pressure, head or brain injuries with increased brain pressures, other traumatic injuries and fractures, lung failure and/or bleeding then the induced coma gives your critically ill loved one the time to recover from their illness.
How can you further leverage your level of PEACE OF MIND, power and influence whilst your loved one is critically ill in Intensive Care and how can you be in control of the situation?
You’ll get to that all important feeling of PEACE OF MIND, power, control and influence when you download your FREE “INSTANT IMPACT” report NOW by entering your email below! In Your FREE “INSTANT IMPACT” report you’ll learn quickly how to get real power and real control and how you can influence decision making fast, whilst your loved one is critically ill in Intensive Care! Your FREE ‘INSTANT IMPACT” Report gives you in-depth insight that you must know whilst your loved one is critically ill or is dying in Intensive Care! Sign up and download your FREE “INSTANT IMPACT” REPORT now by entering your email below!
In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care!
In your FREE reports you’ll also discover
- how to ask the doctors and the nurses the right questions
- Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
- how to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
- 5 “killer” tips& strategies helping you to get on the right path to control, power and influence in your situation
- You’ll get real world examples that you can easily adapt to your situations
- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
- you’ll get crucial ‘behind the scenes’ insight so that you know and understand what is really happening in Intensive Care
- How you need to manage doctors and nurses in Intensive Care(it’s not what you think)
Thank you for tuning into this week’s “YOUR QUESTIONS ANSWERED” and I’ll see you again in another update next week!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
Sincerely, your Friend