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

So, today I have a question from Tom who says, “My mother is in intensive care with a metabolic encephalopathy after open heart surgery, coronary artery bypass grafts. What are treatment options?”

Well, most coronary artery bypass grafts, or many of them, should be straightforward in intensive care. Sort of, you repair the arteries and then one or two days in intensive care, and then patients should go on to a cardiac ward. Should leave intensive care, should get off the ventilator, should get off sedatives, should get off opiates. Should get off inotropes or vasopressors or vasodilators. And the focus should be on rehabilitation and mobilization.

Now, unfortunately, in this situation your mom suffers from complications. So let’s just look what are the most common causes of metabolic encephalopathy in ICU, especially after cardiac surgery. Typically involves obviously and treatment as well involves, treating the underlying cause, providing supportive care, of course, to manage symptoms and prevent further complications.

So, here are the identifying and treating of the underlying cause. This could involve correcting metabolic disturbances such as electrolyte imbalances, managing infections, addressing liver or kidney dysfunction, or adjusting medications contributing to the encephalopathy.

Now, interestingly enough, after open heart surgery or coronary artery bypass grafts, I have seen very frequently electrolyte imbalances, especially potassium, magnesium going down. This is often a result of fluid loss, and blood loss during surgery. But also then sometimes after surgery, people are having or patients are having Lasix or furosemide or diuretics to get urine output going to offload the heart and that can cause further electrolyte imbalances.

Now also managing infections, again, patients after coronary artery bypass grafts are at risk of infection, especially pneumonia because they might be at risk of ventilator-associated pneumonia, especially if there are complications and they stay ventilated for longer than expected. Other infections that are at risk that is obviously postoperatively wound infections is a risk either from the sternotomy or from the chest drains that are in after surgery, addressing liver or kidney dysfunction.

Again, some patients might go into kidney dysfunction after open heart surgery because they might have been hypotensive for too long. So that the kidneys sometimes take a hit because they didn’t get enough blood and blood pressure and therefore oxygen and blood perfusion or adjusting medications contribute to the encephalopathy. Again, that could be sedatives, opiates could be maybe any anti-seizure medications. Let’s look at how else to support and look at supportive care, providing supportive measures to maintain vital functions of course, such as ensuring adequate oxygenation and ventilation, monitoring and managing blood pressure, maintaining fluid and electrolyte balance and preventing complications such as pressure ulcers and infections.

Once again, the intensive care team has to ensure that, all vital functions are within normal limits, and manage blood pressure. If your mom is hypotensive, she might need some fluids, she might need some vasopressors or inotropes.

If she is hypertensive, she might need some anti-hypertensive, she might need some vasodilators, that’s not uncommon after cardiac surgery, and again, maintaining electrolyte balance, maybe replace potassium, replace magnesium. If kidneys are failing, maybe potassium is actually too high, maybe, then diuretics need to be given such as Lasix or furosemide or maybe dialysis or hemofiltration might need to be started.

Of course, preventing complications such as pressure sores or pressure ulcers or infection is also very important because if a patient is immobile, the risk of pressure sores is pretty high. And like I said, the risk for infection is pretty high as I mentioned before.

Now, what medications should be given depending on the underlying cause and symptoms. Medications may be administered to help manage agitation, seizures or other symptoms associated with encephalopathy, sedatives or anti-epileptic drugs may be used as needed. Better if they can be avoided, but sometimes they need to be given in order to manage the situation.

Number four, nutritional support ensuring adequate nutrition either through enteral or parental routes to support brain function and overall recovery. Enteral routes, means, nasogastric tube or PEG (Percutaneous Endoscopic Gastrostomy) tube, and parenteral routes, means, intravenously such as TPN, for example, Total Parenteral Nutrition.

Next, number five is close monitoring. Continuous monitoring of neurological status, vital signs, and lab laboratory values to assess response to treatment and detect any changes or complications promptly.

Number six, rehabilitation. Once the acute phase of encephalopathy is managed rehabilitation measures such as physical therapy, occupational therapy, and speech therapy may be initiated to help improve cognitive function and overall functional status.

So I hope that helps and that answers your questions. Obviously, what’s also important. Close collaboration among ICU healthcare providers including intensivists, neurologists and other specialists, is essential for optimal management of metabolic encephalopathy in intensive care.

So I hope that answers your questions.

If you have any questions that you want to have answered, we have created a membership for families of critically ill patients in intensive care that you can get access to by going to intensivecarehotline.com by clicking on the membership link or by simply going 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.

I also offer one-on-one consulting and advocacy over the phone via Skype Zoom, WhatsApp, or whichever medium works best for you. And I talk to you and your families directly. I talked to doctors and nurses directly in intensive care. And you will see that once I start talking to doctors and nurses directly, and once I set you up with the right questions, you will see that the dynamics change in your favor very, very fast. I have worked in intensive care for nearly 25 years in three different countries. Where I also worked as a nurse unit manager for over five years. I have been consulting and advocating for families in intensive care all over the world since 2013 here at intensivecarehotline.com. And I can say without any hint of exaggeration that we have saved lives with our consulting and advocacy. You can verify that on our testimonial section or on our podcast section with some client interviews.

Also, we offer medical record reviews in real-time so that you can have a second opinion in real-time. I also represent you in family meetings with intensive care teams so that you can have clinical representation. And more importantly, so that you can have a strategy when it comes to interactions with the intensive care team. 99.9% of families in intensive care have no strategy of interacting with intensive care teams. And that’s why they feel hopeless, why they feel they have no control power, and influence. And I can change that for you very, very, very fast.

We also offer medical record reviews after intensive care. If you have unanswered questions if you need closure or if you are simply suspecting medical negligence and 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 support at the intensivecarehotline.com.

Thank you for watching.

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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.