Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

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

So today’s tip is about, another question from a reader. And our reader asks, “My brother has been in ICU for 4 days. They had him on propofol for 4 days. They took him off today. He has a bad liver and bad kidneys. How long will it take for him to wake up?”

So, it really depends here. Propofol is a short-acting sedative. So, when someone is on propofol and you stop propofol, they should wake up pretty quickly. However, the majority of patients in intensive care that are on propofol are often also on opiates such as fentanyl or morphine, sometimes oxycodone as well or Oxycontin, but predominantly morphine and fentanyl.

Now, those are very strong opiates. The reason for sedation, and opiates in intensive care, generally speaking, is the induction of a coma for mechanical ventilation with a breathing tube.

Now, once sedation is stopped, propofol might wean off pretty quickly or might wear off pretty quickly. Now, again, morphine and fentanyl might actually take longer to get out of the body system, especially with a bad liver and bad kidneys. The question is with the bad kidneys, in particular, can the kidneys heal themselves or does your brother need dialysis to potentially clear some of the toxins or to clear propofol? The opiates? That’s one of the questions.

With a bad liver, what does that mean? Does your brother have liver cirrhosis? Are his liver enzymes increased? It’s one thing to say, he’s got a bad liver, the question is how bad is it? So how long will it take for him to wake up?

That’s a difficult question to answer because it all depends on the variables that I just spoke about and it also depends on, I presume, your brother does not have a brain injury. You haven’t mentioned it. I would think you would have mentioned it. But whilst people are in an induced coma, sort of, one of the worst-case scenarios could be that people have a neurological event. Maybe they have a stroke or they have seizures and then waking up might be delayed. Now again, you haven’t shared anything. Did your brother have a cardiac arrest? Potentially with a hypoxic brain injury? I don’t know.  Those are questions that you need to ask. What other variables are there again? Has there been a neurological event?

Now, generally speaking, it can take days, sometimes weeks to wake up after an induced coma, even without a neurological event. If there has been a neurological event, such as a seizure, stroke, head injury, it could take days, weeks, or months, sometimes, it is really hard to say, how long it takes. But even with impaired kidneys and impaired liver, assuming your brother doesn’t have a brain injury, give him a few days and see how he goes. Sometimes people don’t wake up because they’re critically ill and their bodies are tired and wary and they just need time to wake up.

I don’t know how you feel. But, when I’m not feeling well to me, sleep is the best healer and it’s often the same in intensive care. People just need to rest and sleep in order to wake up. So give it some time, and make sure your brother has a good day and night rhythm. Make sure the lights are going off overnight and that’s not always the case in ICU. Make sure he’s got a good day and night rhythm ideally and get him off that ventilator as well. I presume your brother is still on the ventilator and then things should go from there and take care of itself.

So I hope that helps. One more thing as a bonus tip, sometimes when patients are on propofol, during an induced coma in intensive care, they might also end up sometimes on midazolam or, versed which is a Benzodiazepine. It really depends on how deeply your brother needed to be sedated.

And it also comes down to, that the biggest challenge for families in intensive care is 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.

And it doesn’t look to me like you have all the information here that’s really necessary for me to answer your question, which is why I’m looking at different scenarios that I’ve seen in having worked in intensive care for over 20 years. So, I hope that helps if you did have midazolam as an extra sedative, it might even take longer, especially with impaired liver and kidney function.

So that’s 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 our website or simply send us an email to [email protected] with your questions.

Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There, you have access to me and my team 24 hours a day in a membership area and via email and we answer all questions intensive care related.

Also, if you need a medical record review, in real time in intensive care for a second opinion, please contact us as well and we can provide a medical record review in real time. What your loved one is in intensive care and put it all down to you in layman’s terms.

If you need a medical record review after intensive care because you have unanswered questions, you need closure or you are suspecting medical negligence, please contact us as well. We can help you with all of that.

Thank you so much for watching.

Subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have.

Thanks for watching.

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

Take care for now.

Related Articles:

Quick Tip for Families in Intensive Care: When’s a Pt a Candidate for a Ventilator? What Criteria for a Pt No Longer Needing a Ventilator? Case Study: How to Save your Loved One’s Life in ICU or How to Prevent a “One Way Extubation” Quick Tip for Families in ICU: My 80-Year Old Dad’s in ICU After Heart Attack & Now ICU is Saying He’s in Multi organ Failure! Help! Quick Tip for Families in Intensive Care: How to Treat a Cardiac Arrest in Intensive Care! Quick Tip for Families in Intensive Care: Is it Safe for My Grandma to Go to LTAC After Stroke, Tracheostomy, and Nasogastric Tube?