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

So, I’ve had Sarah write in and Sarah says, “My husband has been in an induced coma for seven days in intensive care. And he’s now out of the induced coma. He’s extubated. He’s off the ventilator, has the breathing tube out, but he’s now confused. And I am very confused by seeing this and I don’t know what to make out of it. What should I expect going forward? How long will this last? Will he ever come out of it? It’s been a couple of days now, but he seems to be very confused, aggressive, combative, even at times. And it’s not nice to watch because my husband usually is not like this at all. He’s usually very calm and he’s just not himself at all.”

What a great question, Sarah! When patients come out of an induced coma in intensive care, it really depends on, how long have they been in an induced coma? What medications have they been on? How are they reacting to the medications? And so forth.

Some patients come out of an induced coma and they’re oriented. They have purposeful speech, purposeful movements, everything makes sense of what they’re doing, what they’re saying, and so forth. And then, there are other patients that can be confused, agitated, even combative, and aggressive. They can also be pleasantly confused. I’ve seen all of it after having worked in intensive care for over 20 years. And after having looked after thousands of critically ill patients in intensive care. So, I can totally understand what you’re witnessing there at the moment and that it’s not very nice to watch.

So again, picture this, your husband, would’ve been in an induced coma for a week. He would’ve had a lot of sedative medications such as propofol or midazolam, also known as Versed or Precedex. He would’ve had some morphine, and some fentanyl. Some pretty strong and potent stuff. And now, he’s going to be weaned off some of that or all of that. Some of those medications that I just mentioned are addictive in nature. Which means he might be going through withdrawal from those drugs that might be contributing to the confusion and agitation.  So you got to ask the intensive care team, whether he’s potentially withdrawing from some of the medications that he’s had whilst he was in the induced coma.

Now, next you got to rule out a neurological event. They have to rule out something like a stroke or whether he’s got any seizures, because at the end of the day, you don’t know what happened in those seven days while he was in an induced coma, whilst he couldn’t really communicate with the outside world. Whether he might have had a neurological event such as a stroke. They should be able to rule that out by a CT (computed tomography) of the brain, by an MRI (magnetic resonance imaging) scan of the brain or with an EEG (electroencephalogram). So, how does this subside? It usually subsides over time.

A lot of patients leave intensive care, they’re physically better and they’re physically at the point where they can leave intensive care, but they might still be confused, aggressive, combative, whatever you want to call it. And then eventually once they’re back to more “normality” on a hospital floor, or on a hospital ward, that’s when usually things turn around slowly. But it might take a few days, just be patient and get back to a routine, get back to him, walking around if he can, or having a shower. Just feeling like a human that can often make all the difference in the world.

Just getting back to some natural daylight, maybe he was in a room in ICU with no natural daylight. Getting to go into on a hospital floor or even in ICU where there’s a window, where there’s some natural daylight getting back into a normal day and night rhythm.

A lot of patients in ICU are sleep disturbed and therefore that contributes to them being confused. Imagine if you’re sleep disturbed, you might be, confused or aggressive. However, that plays out for people. But the combination of having all these chemical restraints, plus a disturbed day and night rhythm can lead to confusion and agitation. And as I said, getting back to normality. Getting back to eating, drinking, walking, and having a shower. Things that people enjoy and hopefully it will subside, but it’s not uncommon in ICU. And, time will probably be the best healer here.

That is my quick tip for today.

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

Also, check out our membership for families in intensive care at intensivecaresupport.org.

If you need a review of the medical records of your loved one, we can help you with that as well. And we have a link for that service as well.

Share this video with your friends and families, subscribe to my YouTube channel for regular updates for families in intensive care.

I also do YouTube lives where I can answer questions on the livestream. And I do that usually once a week on a Saturday or on a Sunday.

Like the video, click the notification bell and comment below what you want to see next, or what questions and insights you have from this video.

Thanks for watching.

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