My name is Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care. Here at intensivecarehotline.com, we instantly improve the lives of families of critically ill patients in intensive care so that you can make informed decisions, have peace of mind, control, power, and influence, even if you’re not a doctor or a nurse in intensive care.

Today I have a question from Carol who asks,

“Hi Patrik,

My husband has pneumonia in the ICU and was sedated. Now he seems unable to follow commands right away. What does that mean? How long does it take for sedation to wear off after four days? They want to do an MRI (Magnetic Resonance Imaging). Are MRIs safe?”

Thank you so much, Carol, for your question. This is something I hear all the time from families, and I completely understand your concerns and anxiety right now. When someone like your husband comes into the ICU with severe pneumonia, the treatment typically involves several key components.

Number one, respiratory support, oxygen therapy through high flow nasal cannula, BiPAP or CPAP. In severe cases, intubation and mechanical ventilation to help the lungs rest and recover. This allows the damaged lungs to heal while the ventilator does the work of breathing.

Number two, sedation and opiates during ventilation. When patients are intubated, they receive sedation and opiate medications to keep them comfortable. Common sedatives include Propofol, midazolam, Versed, Precedex, also known as dexmedetomidine, fentanyl, morphine, and others, and fentanyl and morphine would be part of the opiate group. These medications might be necessary but they accumulate in the body, especially after several days, and delay waking up.

Number three, antibiotics and supportive care. Broad-spectrum antibiotics to fight the infection, IV fluids to maintain blood pressure and hydration, medications to support organ function, such as inotropes or vasopressors, also known as norepinephrine, noradrenaline, adrenaline epinephrine, phenylephrine, dobutamine, dopamine, and so forth.

So, why your husband can’t follow commands right away. This is absolutely normal, Carol, and expected after four days of sedation and opiates. Here’s why.

One, sedation and opiate accumulation. After four days, sedative and opiate medications build up in body tissues, especially fat tissue. These drugs don’t just turn off; they need time to be metabolized and eliminated. The liver and kidneys process these medications, but it takes time.

Expect a timeline for sedation to wear off. In the first 6 to 12 hours, the patient may start opening eyes intermittently. 12 to 24 hours may respond to simple commands like squeezing hands, and more consistent responses. After 24 to 48 hours, but still confused or drowsy. 48 to 72 hours, clearer thinking, but they may still have ICU delirium. In several days to a week, full mental clarity should return.

Other important factors that affect recovery time, your husband’s age and overall health, kidney and liver function, type and amount of sedation and opiates used, whether he has any underlying cognitive issues, the severity of his pneumonia, and how much his body has been stressed.

For example, there’s a difference between short-term sedation and long-term sedation. Short-term sedatives are usually Propofol and Precedex. And long-term and long effect sedatives are usually midazolam, also known as Versed, and especially with high doses of midazolam, it can take days and sometimes weeks for patients to wake up, especially if they have high doses of fentanyl and morphine on top of that.

So, what unable to follow commands might mean? Your husband may be in a natural wake-up phase and just needs more time. ICU delirium is very common and can cause confusion, agitation, or delayed responses. His brain is recovering from the stress of severe illness and sedation. This does not necessarily mean permanent brain damage.

And why the ICU team wants an MRI. Now, let me address your concern about the MRI. MRIs are absolutely safe when done properly. Here’s what you need to know. The ICU team likely wants to rule out stroke or brain bleed, hypoxic brain injury, lack of oxygen to the brain, other neurological complications, because all of that could be a reason why he’s not waking up.

MRI safety. MRIs use magnetic fields and radio waves, no radiation. They’re actually much safer than CT (Computed Tomography) scans in that respect. The main risks are related to the transport process from the ICU to radiology. Moving a critically ill patient always carries risk, which is why they only do it when necessary.

The real concern with MRIs in ICU is the risk isn’t the MRI itself, it’s the transport and monitoring challenges. Your husband will need to be disconnected from some ICU equipment temporarily, which is a risk. The team needs to ensure his breathing tube, IV lines, and monitoring stay secure. A portable ventilator will be used during transport, and preparing for an MRI is extremely time consuming. Setting up or cleaning up after an MRI is also extremely time consuming. So I’ve done many MRIs with ventilated ICU patients, and it’s quite a process.

So, what should you do right now, Carol? Number one, get access to all medical records, which is absolutely critical. We need to understand what sedatives, opiates, and in what quantities they were used and at what doses. His oxygen levels before and during intubation, his carbon dioxide levels before and during intubation, whether there were any periods of low blood pressure or low oxygen, lab and pathology results showing kidney and liver function, chest x-rays showing pneumonia progression.

Number two, book a consulting call with me or with one of my team members at intensivecarehotline.com. Here’s why these matters. We can review the medical records with you. We can help you prepare the right questions for the ICU team. We can participate in a three-way conference call with you and the ICU doctors. We advocate and question on your behalf to ensure your husband gets best care and treatment. We can help you understand whether the MRI is truly necessary or if there are alternatives.

Number three, ask the following critical questions. What specific sedation, medications, and opiates were used, when and when were they stopped? What were his oxygen levels during the worst of the pneumonia? Has he had any periods of low blood pressure that might affect brain function? What exactly are they looking for with the MRI? Can they do a CT scan instead, which is faster and easier in the ICU? What is the risk-benefit analysis of transporting him for the MRI?

I also need you to know, Carol, about intensivecareathome.com. This is crucial information that I’m going to share with you right now. If your husband needs long-term ventilation and he needs a tracheostomy, which is invasive ventilation through a tracheostomy or a non-invasive ventilation like BiPAP or CPAP at home without a tracheostomy, or if he needs a tracheostomy without ventilation, and he’s unable to be weaned off the ventilator or the tracheostomy in ICU or in the hospital, or if the family is considering or the patient is considering palliative care, then Intensive Care at Home can help you keep your husband out of ICU predictably and permanently.

Here’s what that means. He could potentially go home with proper support and equipment, 24-hour nursing care with intensive care nurses trained in ventilator management, all the equipment and medications needed at home, a much better quality of life than being in ICU long-term, significantly lower infection risk than staying in hospital. Families can be involved in his care daily.

This option is for patients who can’t be weaned off the ventilator after weeks or months, have chronic respiratory failure, need tracheostomy care long-term, would benefit from ventilation at home rather than in a facility. So go and check out intensivecareathome.com.

So, what happens next? Let’s look at the best-case scenario. The husband continues to wake up gradually over the next two or three days. The MRI shows no significant abnormalities. He progresses with weaning from the ventilator. He recovers cognitive function fully. He’s eventually discharged home or to rehabilitation.

And also keep in mind that waking up after an induced coma is like switching on a light with a dimmer and not with a switch. It’s gradual.

What to watch for, Carol. Gradual improvement in alertness each day, ability to squeeze hands or move eyes on command, recognition of family members, appropriate responses to questions, even if slow.

Red flags to discuss with the team. No improvement in alertness after 5 to 7 days of sedation. No response to painful stimuli, pupils not reacting to light, completely absent reflexes.

Carol, after working with families in intensive care for over 25 years in critical care nursing, I can tell you that delayed waking up after four days of sedation is very common and does not automatically mean something terrible has happened. However, the ICU team is being appropriately cautious by wanting to do an MRI. This is actually good medical practice. They’re ruling out complications.

But here’s what I strongly recommend. Call me immediately at intensivecarehotline.com so we can review all medical records with you, help you understand what’s normal versus concerning. Make a conference call with the ICU team on your behalf and with you on the phone. Make sure all the right questions are being asked. Advocate for your husband’s best interest. Help you make informed decisions, have peace of mind, control, power and influence about testing and treatment. Because you don’t have to navigate this alone. That’s exactly why Intensive Care Hotline exists.

Now, take action right now. Subscribe to my YouTube channel for more videos like this where I answer family’s most pressing ICU questions and subscribe to our email newsletter at intensivecarehotline.com.

Now, final thoughts, Carol, your husband’s inability to follow commands right away after four days of sedation is most likely a normal part of recovery, but having expert support, access to medical records, and proper advocacy will make all the difference in his outcome. The MRI is safe; the concern is the transport, and that’s a legitimate discussion to have with the ICU team about risks and benefits.

Don’t wait. Reach out to intensivecarehotline.com today.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over five years in intensive care. And I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. And I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights, and you can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section, where we have done client interviews.

And because our advice is absolutely life-changing, right? 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 why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always. And that’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

And that’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. And I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. And when I talk to families directly, I also talk to doctors and nurses directly, asking 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, so, if, in case you have unanswered questions, if you need closure or if you are suspecting medical negligence.

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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.