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

Today’s tip is about, “Why is an induced coma necessary when it comes to sepsis in intensive care?” And that is a really great question, and it is a question that we get quite frequently because people don’t seem to understand initially why an induced coma might be necessary for something like sepsis.

So, when patients go into intensive care with sepsis, sepsis is a potentially fatal or lethal whole-body inflammation caused by a severe infection. And most infections are caused either in the lungs, in the bloodstream, or in the urine, and those are the most important causes. Could also be caused through an abdominal sepsis of the trauma, could also be caused by that.

Quickly signs and symptoms of sepsis, obviously fever, rapid breathing, elevated heart rate, decreased urine output, confusion, elevated blood sugar, sometimes metabolic acidosis, respiratory alkalosis, and low blood pressure  in particular, which is what often gets people into intensive care in the first place, which also causes a low perfusion of the organs because of the low blood pressure, i.e., major organs such as the heart,  kidneys, liver, lungs, are not perfused properly which will lead me to why an induced coma is necessary in a minute.

Other signs and symptoms, more medical, but I still want to mention it is decreased systemic vascular resistance, which is again, causes the blood pressure to drop.  Also, dysfunction of the blood coagulation. There’s an increased risk of bleeding. Again, the causes of sepsis, most common sources are in the lungs, in the abdominal, for example, through abdominal trauma and the urinary tract. Therefore, patients in intensive care need to have a few tests done, i.e., blood test, a blood culture  to see whether the infection is in the blood. Number two, a sputum sample to see whether the infection is in the lungs. And number three, a urinary sample to see if the infection is in the urine and also to determine the cause of the bacteria and then treated with the right antibiotic. In any case, when patients go into ICU in with sepsis or septic shock even, antibiotics should be started as quickly as possible to reduce the risk of mortality, to reduce the risk of death.

Now, how is it treated? So, all major organs need to be supported appropriately. If there’s dysfunction from the organs, for example, hemodialysis in kidney failure, and now we come to the induced coma mechanical ventilation when it comes to the sepsis originating in the lungs, i.e., maybe a pneumonia. And that could mean initially oxygen is given. It could mean if oxygen isn’t sufficient, then maybe the patient needs to be started on BIPAP (bilevel positive airway pressure) with a mask. And if that’s not sufficient, then an induced coma is necessary to intubate a patient. And that’s when an induced coma is necessary.  But let’s just quickly stick with other aspects of the sepsis in ICU.

Fluid therapy also needs to be started. Often, again, when the blood pressure drops, first line treatment is giving IV fluids, potentially giving inotropes or vasopressors if a fluid challenge doesn’t bring up the blood pressure. And again, if the blood pressure is low, that also means oxygenation of the organs is low, which is why you need to start patients on oxygen, potentially on BIPAP, CPAP (Continuous positive airway pressure).  And then they might need to be induced into a coma for mechanical ventilation depending on blood gas results. Depending on chest x-rays, depending on the clinical picture, that’s obviously evolving.

Now also, you want to start ventilating a patient and inducing them into a coma to reduce oxygen demand because again, if blood pressure is low, the organs need oxygen, and you don’t want to distress the organs. And again, that’s why it might help to induce someone into a coma and then start ventilating them.

So, I hope that really helps in this quick tip that you understand why sepsis in intensive care often requires induced coma and ventilation. Very few I have seen very few patients in intensive care and over 20 years of working in ICU in three different countries that weren’t ventilated and in an induced coma with sepsis or a septic shock.   And I hope that helps you understand what’s really happening.

I can also break down, what else is happening when it comes to sepsis and septic shock in another video, look more about the treatment in detail. But I can do that in another video. Let me know if you want to see that as well.  And then I will make that video as well.

Now, if you have a loved one in intensive care, go to intensivecarehotline.com and call us on one of the numbers on the top of our website or simply send us an email to [email protected].

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 for your loved one in intensive care, please contact us as well. We review medical records in real time when you have your loved one in intensive care. And we also review medical records after intensive care if you have unanswered questions,  if you have suspicions, there might be medical negligence, or if you simply need closure.

Now, like the video, subscribe to my YouTube   channel for regular updates for families in intensive care, click the like button, share the video with your friends and families, and click the notification bell, so you get notified for new videos.

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.