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

So, today’s tip is about a question that we have from a reader who says, “Why is my grandfather not opening his eyes and not fully functioning even after the sedatives and the painkillers are reduced?” What a great question. So, let’s look at the bigger picture here.

When patients are in intensive care on a ventilator with a breathing tube, they are often induced into a coma with sedatives and opiates. Opiates are strong painkillers such as morphine and fentanyl. Sedatives that are often used in intensive care are propofol, midazolam/Versed, and sometimes Precedex as well. Precedex is dexmedetomidine.

Depending on the length of a coma, patients may or may not wake up quickly. Depending on what other things are going on, they may or may not wake up quickly. Depending on the dosage of sedatives and opiates used, patients may or may not wake up quickly and properly. Depending on whether that patient, for example, is having impaired kidney or liver function, they may or may not wake up quickly. So, you can already see there are many, many variables in this and it’s often not a straightforward process.

So, families in intensive care get told, “Ok, we’re now taking off sedation, we’re reducing sedation and opiates, and then your loved one should wake up”, and many times they don’t, at least, not quickly. Everyone expects to be a quick fix there.

Now, here is another reason why patients don’t wake up quickly is because they’re critically ill. Whatever got them in the induced coma in the first place is a critical illness. Now, you’d expect that someone with a critical illness is not just waking up like switching on a light with a switch. It’s more like switching on a light with a dimmer. So, it’s a gradual process.

Now, here is another reason why patients in intensive care that are critically ill and have been in an induced coma are not waking up quickly. So, they may have had a neurological event, i.e., they may have had a stroke, God forbid, they may have had some seizures while being in the induced coma. So, if someone is not waking up after a few days, a neurological consult should be sought, and a CT brain scan should be done, an MRI scan of the brain should be done to rule out any neurological damage or neurological event.

Now also, let’s just look at the best-case scenario here. Let’s just say someone is in an induced coma after open heart surgery, they’re coming back to ICU, they’re on a breathing tube, they are a little bit hemodynamically unstable because they just had open heart surgery, they might be on some propofol, they might be on some morphine or fentanyl for the pain. If they’re stable overnight, the next morning, you take off sedation and you still leave the morphine or the fentanyl because it’s quite painful when they crack open a chest after open heart surgery. Then a patient ideally should wake up. That’s what I’ve often seen.

But then, sometimes depending on the patient’s age and comorbidities, they don’t wake up quickly. Then, you’ve got to leave them intubated for another couple of days until they’re more awake. So, it’s not a straightforward process. It’s not a one size fits all.

Another example is if someone has been on midazolam or Versed for many days, that’s a long-acting sedative versus propofol is a short-acting sedative, which means when someone is on propofol and you switch it off, they should wake up pretty quickly. When someone is on midazolam or has been on midazolam for many days, depending on the dosages, if they are high dosages, you don’t expect that patient to wake up pretty quickly there can be delays. So, you can see there are so many variables why patients may or may not wake up. So, don’t despair. Give it some time.

I’ve made counters of videos about, “When patients are not waking up in intensive care, what to do?” Sometimes you simply need to wait. If, for whatever reason, your grandfather isn’t waking up, other measures that could be taken are using antidotes to sedatives to reverse the effects of midazolam, to reverse the effects of morphine or fentanyl.

If they’re not waking up, then definitely need to seek a neurological consult. But please keep in mind the bigger picture here, your grandfather must be critically ill. He’s pretty crook, let’s call it for what it is. That in and of itself might simply delay him waking up and he’ll probably come around in his own time.

People do things in their own time, as much as we all want to speed up things, let nature take its course so to speak, and let him wake up in his own time. Keep talking to him, keep holding his hand, make sure he’s getting good nursing care, he’s getting good stimulation, and give him some time. Make sure they sit him up, make sure they give him physical therapy, and hopefully, he’ll wake up in due course. Don’t despair. Keep going.

So, 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 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 the membership area and via email and we answer all questions, intensive care related.

I also offer one-to-one consulting and advocacy over the phone, via Skype, via Zoom, via WhatsApp, whichever medium works best for you. I talk to doctors and nurses directly, ask all the questions you haven’t even considered asking, and changing the dynamics very, very quickly for you. So, the intensive care team knows you have someone on your team that understands intensive care inside out and understands it just as well as they do with the added-on twist that I advocate for you and your family member.

If you need a medical record review and you want a second opinion in real-time, we do that as well. Please contact us for a medical record review in real-time. We also review medical records after intensive care if you have unanswered questions, if you need closure, or if you’re simply suspecting medical negligence.

Now, if you find value in this video, give it a thumbs up, give it a like, subscribe to my YouTube channel for regular updates for families in intensive care, click the subscribe 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 from this video.

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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