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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

Today, I’ve got a question from a reader who says, “I want the ICU team to give my mom time after a stroke and sedation to see if she will respond. They stopped sedation, but they’re already pushing towards end-of-life or a tracheostomy if she doesn’t wake up. How long is too long for her not to wake up?” What a great question, especially after a stroke and after sedation.

So, first off from my experience and I have worked in intensive care for over 20 years in three different countries. From my experience, it simply takes time. And that time can’t be limited by artificial timelines from intensive care teams who manage beds, or who manage budgets, who manage staff. Time to wake up is simply guided by a patient, by therapy, and by treatment.

A lot of it comes down to what sedatives has your mom been on? Has she been on long-acting sedatives? Has she been on short-acting sedatives? Short-acting sedatives are usually medications such as propofol. Long-acting sedatives are usually medications such as midazolam or Versed. Sometimes, these days, there’s also Precedex being used as a sedative and Precedex is somewhere in the middle.

It also depends on how many opiates  she had, like morphine or fentanyl while she was under sedation. On top of that, obviously, your mom had a stroke and a lot of it comes down to what type of stroke did she have? Did she have any ischemic stroke? Meaning a lack of oxygen to the brain. Or did she have a hemorrhagic stroke? Meaning a bleeding stroke and a blood vessel rupturing in the brain and causing a bleed. So, a lot of it comes down to that as well. What does the MRI (magnetic resonance imaging) scan of the brain or the CT (computed tomography) scan show off the brain has some irreversible damage being done? Those are all questions that need to be asked.

Then the next question is, how long can it take to wake up? Well, it can take hours. It can take days. It can take weeks. It can take months. It really comes down to, does your mom have an advanced care plan? Does she have explicit wishes documented? And if she doesn’t have them documented, has she verbalized them in the past to you? It should be guided by your mom’s and by your family’s wishes after all.

Now next, if your mom doesn’t wake up and therefore can’t protect her airway, that means she might need a tracheostomy after about 10 to 14 days of not waking up, being ventilator dependent. But what’s also important is if she’s not waking up, it’s also important for ICU teams to mobilize your mom. Even though with a breathing tube, she can get in a tilt table chair or in a recliner chair. That’s all possible. Sitting up, sitting on the edge of the bed, that’s all possible because with stimuli often comes waking up. You can’t wake up if you’re lying in bed all day, especially after a stroke. The sooner you can start rehabilitation, the sooner you can start physical therapy, the higher chances are of recovery.

Next, even if your mom does wake up, the question after a stroke is often how much neurological damage is there? For example, even if she can breathe spontaneously in a pressure support or in a CPAP (continuous positive airway pressure) mode, can she swallow? That is often impacted after a stroke. She might be able to get off the ventilator, but she might still need a tracheostomy without a ventilator because she can’t swallow. Again, it all comes down to rehabilitation, giving patients time, starting physical therapy as quickly as possible, starting mobilization, starting swallowing assessments, starting speech therapy, and see how quickly you can make progress.

And again, if your mom wants to live, then she should have a tracheostomy. If she can’t come off the ventilator , she might need a tracheostomy until she can swallow. And that’s probably, the outlook here with the stroke in particular. Not all stroke patients end up in ICU. If your mom ended up in ICU, there’s a good chance the stroke was more severe than others.

So, that is my quick tip for today.

I hope this helps.

If you have a loved one in intensive care, go to intensivecarehotline.com and call us on one of the numbers on the top of our website, or simply send us an email to [email protected].

Also, have a look at our membership for families in intensive care at intensivecaresupport.org.

We also offer medical record reviews for patients in intensive care or after intensive care, go and contact us for that as well.

And if you like this video, share it with your friends and families, subscribe to my YouTube channel here for regular updates for families in intensive care, click the notification bell, comment below what do you want to see next.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.