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Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we instantly improve the lives of Families of critically ill Patients in Intensive Care, so that you can have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I wrote about
“How long can you keep a critically ill Patient in Intensive Care in an induced coma?”
Check it out here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer another question of one of our reader’s whose husband is in Intensive Care after an induced coma, off the ventilator and is now confused.
Jelena from Toronto, Canada
Hi Patrik,
My husband has had severe pneumonia and was on a breathing tube for several days and was heavily sedated in the ICU.
His condition is improving and he had been taken off the ventilator. The issue is that although he has been off the ventilator and has been now awake for about 5 days, he is still very confused, agitated and not cooperative. The psychiatrists are medicating him with very strong medication (anti-psychosis meds) to calm him down. He is not sleeping and is not eating.
In some moments he does recognize me and asks about our daughter. Other times, he is not sure what is happening, is confused and mumbles a lot.
I am curious why he is being given such strong medication. Can any of this medication be substituted? Is it normal that he’s acting that way? How long can this last?
Is there anything else I can do?
Thank you,
Dear Jelena,
thank you for your email.
I appreciate the time you are taking to write this email and I understand the emotional pain and the frustration you are going through in this difficult and challenging time in your, your husband’s and in your Family’s life.
In order to answer your questions that relate to your husband’s situation there are a few things that can happen in Intensive Care after a prolonged induced coma.
- “waking up” is not linear or “straight forward” because of all the sedatives and opiates that have been given and accumulated during the induced coma in your loved one’s body
- the body system needs to “get rid” of all the drugs and medications in the body system first before your husband will “make sense” again
- Furthermore, keep in mind that if your husband has been in Intensive Care with Pneumonia, ventilated and in an induced coma, that he has been quite sick. Therefore he has been weak and his health has just been compromised big time. The sickness and the induced coma are most likely causing the situation your loved one is in
- The confusion, agitation and non- cooperation is often also triggered by the environment, with other people being in control, the sickness and just by simply everything that’s going on in a busy Intensive Care Unit
- You must know that a large percentage of ICU Patients after an induced coma are not waking “properly” and they are often not “waking up” as quick as you and the Intensive Care team would like them to wake up, but it’s nothing unusual and it happens all the time in Intensive Care
- Moreover, you don’t say how old your husband is, however generally speaking, the older Patients are, the higher the risk and the likelihood that “waking up” after an induced coma is getting delayed and more difficult. Also know that many ICU Patients go through the “ICU related Psychosis” phase, just simply as a result of being in ICU, by being sick and by being on a ventilator/ respirator and in an induced coma
- The good thing that I can see in your situation is that at least your husband is off the ventilator/ respirator and it sounds to me like he is able to stay off the ventilator/ respirator, which is a very good thing and is probably also more important than the confusion, agitation and non- cooperation. The last thing you would want is to have your husband go back on a ventilator/ respirator
- In regards to your loved one getting strong medication(anti- psychosis meds) to manage his confusion, agitation and non- cooperation, you need to know a few things. My experience has shown that Intensive Care teams tends to be very quick in giving those “behavioural” drugs(anti- psychosis meds) in order to “manage” your loved one. I am personally not a huge friend of those drugs, however I’m also aware of the limitations of non- medication management if Patients are confused, agitated and non- cooperative. Therefore, if the Intensive Care team has tried to manage your husband with their communication skills and their expertise and have failed, their next step is to give him anti- psychotic drugs such as Haloperidol, Clonidine, Olanzepine or Diazepam(Valium) to name a few. The problem often is that by giving those drugs that your husband gets “knocked out” and very sleepy to the point where the situation may actually get worse before it actually gets better. There is also the risk of your husband getting too sleepy so that he would have to be put back on a ventilator/ respirator again.
Normally, as a first step after the induced coma, it is very important that the Intensive Care team gets your husband into a “normal” routine and I have found that it is very important to take good care of your husband’s hygiene needs such as brushing teeth and doing regular mouth care, but also things like regular washes and a shower can do wonders and is often the better path, compared to managing the situation with drugs.
Good nursing care can make a big difference!
Do you think that your husband is getting good nursing care? Also think about things like getting some natural daylight if he’s in a room without natural daylight. Do you think that the Intensive Care team has considered any of it? If you find that they have, great and if you find that they haven’t ask for it and don’t be shy about it!
You also mentioned that your husband has lost appetite, which is nothing unusual in ICU, however is the Intensive Care team giving him some nutrition via a feeding tube or intravenously? Have they considered this? Also, if he likes any specific food, bring it in and give it to him. Nutrition can help as well, especially if he’s weak.
Sometimes, however even good nursing care might not help and then medication management with anti- psychosis meds might be indicated but it should be the last resort. If you find that all other attempts to manage the situation have failed then medication management is the right thing to do and your patience will be tested. Normally it takes a good few days until your husband will be “normal” and cooperative again. Very rarely have I seen confusion, agitation and non- cooperation seen last for longer than 7 days, however those 7 days can be a test to your patience of course.
Other things you can do are things like playing his favourite music, bring pictures of your loved ones, familiar tastes, smells etc… might also help to get your husband back to normal.
Also check out this blog post here to give you more insight about confusion, agitation and delirium in Intensive Care(click on the link below)
I hope that this helps and please let me know if you have any other questions.
I would also be available to have a chat on Skype (Skype ID patrik.hutzel) if you need more help.
You also should get more education about Intensive Care as otherwise the Intensive Care team will put their agenda on you and your critically ill loved one and you wind up with no power, control and influence.
How can you leverage your level of power, influence and control whilst your loved one is critically ill in Intensive Care?
You’ll get to that all important feeling of power, control and influence when you download your FREE “INSTANT IMPACT” report NOW by entering your email below! In Your FREE “INSTANT IMPACT” report you’ll learn quickly how to get real power and real control and how you can influence decision making fast, whilst your loved one is critically ill in Intensive Care! Our FREE reports help you with in-depth insight that you must know whilst your loved one is critically ill or is dying in Intensive Care! Sign up for your FREE membership and download your FREE “INSTANT IMPACT” REPORT now!
In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care!
In your FREE report you’ll also discover
- How to ask the doctors and the nurses the right questions
- Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
- How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
- 5 “killer” tips& strategies helping you to get on the right path to PEACE OF MIND, control, power and influence in your situation
- You’ll get real world examples that you can easily adapt to your and your critically ill loved one’s situation
- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
- You’ll get crucial ‘behind the scenes’ insight so that you know and understand what is really happening in Intensive Care
- How you need to manage doctors and nurses in Intensive Care(it’s not what you think)
Thank you for tuning into this week’s episode of “your questions answered” and I’ll see you again in another update next week! Make sure you also check out our “blog” section for more tips and strategies or send me an email to [email protected] with your questions!
Also check out our Products section where you get more Ebooks, Videos and Audio recordings and where you can also get 1:1 consulting!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
Your Friend
Patrik Hutzel
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