My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care. At intensivecarehotline.com, we improve the lives for families of critically ill patients in intensive care instantly so that you can make informed decisions, have peace of mind, control, power and influence, making sure your loved one always gets best care and treatment, even if you’re not a doctor or a nurse in intensive care.

Tonya reached out to us recently and wrote:

Hi Patrik,

“My husband is not waking up after open heart surgery, not responding to anything but is now responding to pain — nothing else.

Could that be involuntary movement or is it actually him doing it?”

-Tonya

Tonya, this is an incredibly important question, and I want to give you a thorough, honest answer — because what is happening right now could have several very different explanations, and you deserve to understand all of them.

I have helped hundreds of families navigate exactly the kind of situation you are in right now.

Let me walk you through everything you need to know.

Why Is Your Husband Not Waking Up After Open Heart Surgery?

When a patient does not wake up after open heart surgery and is still on a ventilator, there are several possible reasons. Some are expected and temporary. Others are more serious. The key is getting clarity from the ICU team — and that requires asking the right questions and having someone who knows how to interpret the answers on your side.

Here are the most common reasons a patient may not be waking up after having open heart surgery:

1. Prolonged Sedation and Opiates

Open heart surgery is a major operation. Patients are placed on general anesthesia during the procedure and are often kept sedated after surgery in the ICU to keep them comfortable while on the ventilator. In some cases, sedation takes longer than expected to wear off — particularly in older patients, patients with liver or kidney issues, or patients who required large doses during surgery.

If your husband is still on sedative or pain-relieving medications — even at low doses — these can suppress consciousness and mask his true neurological status. This is one of the most common and treatable reasons for not waking up after surgery.

KEY QUESTION TO ASK: Has sedation been fully weaned? What medications is he currently receiving that could suppress his level of consciousness?

2. Hypoxic Brain Injury

Open heart surgery requires the use of a cardiopulmonary bypass machine — a heart-lung machine — that takes over the function of the heart and lungs during the operation. In some cases, the brain may not receive adequate oxygen during or around the time of surgery, leading to what is called a hypoxic brain injury.

Hypoxic brain injuries exist on a spectrum. Mild hypoxic brain injuries may result in temporary confusion, slow awakening, or short-term memory issues. More severe hypoxic brain injuries can result in prolonged unconsciousness or, in the most serious cases, disorders of consciousness.

KEY QUESTION TO ASK: Were there any periods of low blood pressure or low oxygen during or after the surgery? Has a CT scan or MRI of the brain been performed?

3. Stroke During or After Open Heart Surgery

Stroke is one of the known complications of open-heart surgery. The cardiopulmonary bypass machine, the manipulation of the aorta during surgery, and the systemic inflammatory response that follows major cardiac surgery can all increase the risk of blood clots or emboli travelling to the brain.

A stroke affecting areas of the brain responsible for consciousness and responsiveness can result in a patient who is deeply unresponsive or only responding to pain stimulation — exactly what Tonya is describing with her husband.

KEY QUESTION TO ASK: Has your husband had a brain CT scan or MRI? Has a neurologist been consulted? Has stroke been formally ruled out or identified?

4. Metabolic and Organ-Related Causes

After major surgery, the body is under enormous physiological stress. The kidneys, liver, and other organs can be affected, and when they are not functioning properly, waste products and toxins can accumulate in the bloodstream and affect brain function — a condition known as metabolic encephalopathy.

Common metabolic causes of reduced consciousness after open heart surgery include:

• Acute kidney injury leading to uremia (toxin buildup)
• Liver dysfunction
• Electrolyte imbalances such as sodium or glucose abnormalities
• Carbon dioxide retention due to ventilator settings or lung complications
• Infection or sepsis following surgery

KEY QUESTION TO ASK: What do your husband’s blood tests show? Are his kidneys and liver functioning normally? Is there any sign of infection or sepsis?

5. Cardiac Complications After Surgery

In some cases, the heart does not function well after open heart surgery. Low cardiac output — meaning the heart is not pumping enough blood to the body and brain — can cause or worsen reduced consciousness. This may also require medications or even mechanical support devices to assist the heart.

KEY QUESTION TO ASK: How is your husband’s heart function now? What is his cardiac output? Is he on any medications or devices to support his heart?

6. Seizures

Seizures after cardiac surgery can occur and are not always obvious. Some seizures — called non-convulsive seizures — do not involve visible shaking or movement and can only be detected with an EEG (electroencephalogram) test. Seizures can significantly suppress consciousness.

KEY QUESTION TO ASK: Has your husband had an EEG? Have seizures been considered or ruled out?

7. Cardiac tamponade or post-surgery bleeding.

It requires a return to the operating theater for removal of the cardiac tamponade or to stop the bleeding. This requires another anesthesia, more sedation and opiates and can delay Waking up significantly.

Is Responding to Pain Involuntary or Purposeful? This Is Critical.

Tonya, you asked a very perceptive question. You want to know: is your husband’s response to pain involuntary — a simple reflex — or is it actually him consciously responding?

This is one of the most important distinctions in critical care neurology, and the answer matters enormously to understand what is happening in his brain.

Involuntary Pain Responses (Reflexes)

Some pain responses are purely spinal reflex arcs — they do not involve the brain at all. For example, if you stimulate the sole of the foot and the leg withdraw, this can happen even in patients with severe brain injury. These are called withdrawal reflexes and they are automatic. They do not require consciousness.

Other involuntary responses include abnormal posturing — either decorticate posturing (arms bend inward) or decerebrate posturing (arms and legs extend rigidly). These responses to pain actually indicate serious brain dysfunction and are not signs of purposeful movement.

Purposeful Pain Responses (Conscious Responses)

A purposeful response to pain is different. It means the patient is making a conscious, goal-directed movement in response to the painful stimulus. Examples include:

• Reaching up to try to push away a painful stimulus
• Turning the head away from the pain
• Attempting to grab the hand that is causing the pain
• Moving in a coordinated way that suggests awareness

Purposeful responses are a much more encouraging sign than reflexive responses. They suggest that some level of brain function and awareness is present.

Here is the reality: only the bedside ICU team can properly assess and distinguish between reflexive and purposeful responses — but you have every right to ask them directly: “When my husband responds to pain, is this a purposeful response or a reflex? And what does that tell you about his brain function?”

What Tests Should Be Done and What Questions Should You Ask?

If your husband is not waking up after open heart surgery, you need answers — and to get answers, specific investigations need to happen. Do not assume these have been done. Ask directly.

Here is what should be considered:

• CT scan of the brain — to look for stroke, bleeding, or swelling
• MRI of the brain — more sensitive than CT for identifying areas of injury
• EEG — to rule out non-convulsive seizures
• Neurological assessment and neurology consultation
• Full blood panel — kidney function, liver function, electrolytes, glucose, inflammatory markers
• Assessment of sedation and pain medications currently on board
• Review of intraoperative records — what happened during surgery?
• Echocardiogram — to assess current heart function

You also need to ask the ICU team to clearly explain what they believe is causing your husband’s lack of responsiveness. If they cannot give you a clear answer, that is a problem — and that is exactly where we at Intensive Care Hotline can help.

Why Having Access to All Medical Records Is Non-Negotiable

One of the most important things I tell every family in your situation: you must have access to all of your husband’s medical records. This includes:

• Surgical and anesthetic records from the day of the operation
• ICU nursing notes and observation charts
• All blood test results and imaging reports
• Medication administration records
• Any specialist consultations that have taken place
• ventilation parameters
• vital signs and clinical observations
• fluid balance charts

Medical records are not just your right — they are your most powerful tool. They allow you and an experienced advocate to see exactly what has happened, identify gaps in care, understand what investigations have and have not been done, and make informed decisions.

In our experience at Intensive Care Hotline, families who obtain and review medical records frequently discover important information that was never communicated to them verbally. Do not wait to request these records.

How Intensive Care Hotline Can Help You Right Now

Tonya, if you are sitting in that waiting room — or watching your husband through a window — and you feel lost, overwhelmed, and like you are not getting straight answers, I want you to know there is help available.

At Intensive Care Hotline, we offer consulting calls where I personally, or a member of my experienced critical care team, will:

• Review your husband’s medical records and test results with you
• Explain in plain language exactly what is happening and why
• Prepare you with the right questions to ask the ICU team
• Join a three-way call with you and the ICU team to ask those questions directly and advocate on your behalf
• Help you understand all treatment options and what the realistic prognosis looks like
• Make sure your husband is getting all the care he needs and that nothing is missing.

We have helped families in the USA, Canada, UK, Australia, New Zealand, Ireland, India and many other countries around the world navigate the most complex ICU situations — including patients who were not waking up after cardiac surgery, who went on to recover, be weaned off the ventilator, and come home.

Visit Intensive Care Hotline to get help now

What If Long-Term Ventilation Becomes a Reality?

I want to be very direct with you, Tonya — and with every family reading this. In some cases, patients who do not wake up after open heart surgery have sustained significant enough brain or organ injury that require long-term ventilation. This could mean invasive mechanical ventilation through a tracheostomy, or non-invasive ventilation such as BiPAP. It can also include tracheostomy care without the need for ventilation.

If that becomes your husband’s situation, it does not automatically mean he has to remain in hospital for the rest of his life.

Intensive Care at Home — our specialist home nursing service — is Australia’s only third-party accredited provider of intensive care nursing at home for ventilator-dependent adults and children. We are ISO 9001:2015 and NDIS Quality and Safety Commission certified, audited by BSI Group with zero non-conformances.

We provide highly specialized Critical Care Registered Nurses who can care for ventilator-dependent patients in the comfort of their own home — whether they are on invasive mechanical ventilation via tracheostomy, non-invasive ventilation, tracheostomy without ventilation, even in palliative care settings.

Going home with a tracheostomy or on a ventilator is not the end. For many of our patients, it is the beginning of a much better quality of life than what the ICU or a nursing facility could ever offer.

If you want to know more about this option, visit www.intensivecareathome.com and call us.

If you are in the USA, Canada, UK, India or any other country and you need INTENSIVE CARE AT HOME, please call us as well. We can help you in other countries as well!

What You Should Do Right Now

If your loved one is not waking up after open heart surgery, here is what I want you to do today:

• Request all medical records immediately — surgical notes, ICU charts, blood results, imaging reports
• Ask the ICU team directly what investigations have been done to find out why he is not waking up
• Ask whether his pain response is reflexive or purposeful — and what that means
• Ask for a neurology consultation if one has not already occurred
• Call us at Intensive Care Hotline so we can help you get answers, advocate for your husband, and make sure nothing is missed.

Call us now at www.intensivecarehotline.com or send me an email to [email protected]. You can also book a call with me here https://intensivecarehotline.com/scheduling-appointment/

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.

That’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

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

Take care for now.