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

I have an email from Andy who says,

“Hi Patrik,

My dad had COVID pneumonia and he’s on a ventilator for almost two weeks now, he hasn’t woken up. They just took him off fentanyl and midazolam/Versed. He was on the lower dose of sedation. He’s over 65. When will he wake up?”

Thank you, Andy, for sharing your dad’s situation with me.

Now, here is one of the issues. So, many patients after an induced coma, don’t wake up. It’s a bit like switching on a light with a dimmer instead of switching on the light with a switch. It’s a gradual process especially, after two weeks, a lot of things can happen in two weeks.

One of the things that can happen in two weeks is that morphine or fentanyl, the opiates that he’s on, and midazolam end up in the tissues of the body. Therefore, don’t get metabolized and don’t get excreted very quickly. Therefore, there’s a delay in waking up. That is one of the things that can happen.

Another thing that can happen is he simply had too many sedatives and opiates. Once again, it takes a long time for it to be metabolized or getting washed out of the body. That’s another thing that can happen.

Another thing that can happen is your dad is simply critically ill and needs time to rest and heal.

Another thing that can happen during an induced coma, especially during a prolonged induced coma, which two weeks in my eyes is a prolonged induced coma, is that he might have had a neurological event such as a stroke, some seizures, some brain bleed. Who knows? If he’s not waking up when sedation and opiates are switched off, they need to check for that. They need to find out whether he had a neurological event.

Now, other things that can happen during the prolonged induced coma is your dad might be in kidney failure and the kidneys might not work 100%. Once again, it simply then takes longer for opiates or sedatives to be washed out of the body. It’s just a reality.

Other things that can happen is that the liver might be impacted once again. If the liver is impacted, then it takes longer for the medications to be metabolized and it takes longer for the medication to get out of the body system, also causing a delay in waking up.

Now, another thing that is important to understand, especially when it comes to medications such as morphine, fentanyl, midazolam/Versed. Versed is a benzodiazepine and both opiates and benzodiazepines are addictive in nature. So, someone coming out of induced coma might also go into withdrawal from the highly addictive sedatives. So, there’s quite a few things that are happening here.

Also, if your dad is not coming out of the induced coma, that also means he’s probably having a lower blood pressure because he’s not awake yet. Does he therefore need inotropes or vasopressors to stabilize his blood pressure? So, there are a number of dynamics at play in a situation like that.

Also, what you need to pay attention to is when someone is in an induced coma and isn’t waking up, they are deconditioning in real time there. There’s muscle wastage and so deconditioning is real. So, they now should be starting some physical therapy or physiotherapy to get him out of the induced coma and help him to wake up. Even going as far as ideally sitting out of bed.

Now, you haven’t said whether your dad is ventilated with a breathing tube or with a tracheostomy. If he still has a breathing tube in his throat and he’s not waking up, especially after two weeks, they do need to consider to do a tracheostomy. The breathing tube in the mouth can only stay in for so long, usually around the two-week mark and he’s past that.

So, that sort of sums up your dad’s situation, I think pretty well with what you’ve shared. There might be other things happening that you haven’t shared that you simply don’t know.

It’s also 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, and that’s probably exactly what you are dealing with here, Andy.

Because I worked in critical care for nearly 25 years in three different countries, that’s also why I can answer those questions that you guys have, confidently. I’ve worked in critical care for nearly 25 years. I’ve also worked as a nurse manager for over 5 years in critical care. I’ve been consulting and advocating here at intensivecarehotline.com since 2013.

We have been saving many lives with our consulting and advocacy. You can verify that on our testimonial section. You can read our testimonial section at intensivecarehotline.com and click on the testimonial section or you can watch some of our video podcasts that we’ve done with our clients, verifying the work that we’ve done saving lives with our consulting and advocacy.

Because we’re getting so many questions from families in intensive care. This is a question from Andy, from April. We’re getting so many questions we can’t keep up, but that’s why we also created a membership for families of critically ill patients. 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 e-books and 21 videos that I have personally written and recorded with all my two and a half worth decades of ICU experience and the access to me and my team as well as the exclusive access to e-books and videos will help you make informed decisions, get peace of mind, control, power, and influence and also making sure your loved one gets best care and treatment.

I also offer one-on-one consulting and advocacy over the phone, Skype, WhatsApp, Zoom, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly as well. Once again, all with the goal of making sure you make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment. When I talk to doctors and nurses directly, I ask 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 you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

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

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, comment below what you want to see next, what questions and insights you have.

Because we get so many questions on YouTube and via email if you want to have your YouTube video done or email read out as quickly as possible and get it answered, make a small donation with a Super Chat button on YouTube. I’ll get to it that also helps us to make as many videos as possible here for our audience, for families in intensive care to help us support you with a small donation and that is much appreciated.

Now, I also do a weekly YouTube live where I answer your questions live on the show and you will get notification for the YouTube live if you are a subscriber to my YouTube channel or if you are a subscriber to our email newsletter at intensivecarehotline.com.

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.

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