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Quick Tip for Families in ICU: My Mother Had Emergency Open Heart Surgery During TAVR (Transcatheter Aortic Valve Replacement) Surgery & Now is on a Ventilator Day 4, Help!

If you want to know what to do when your mother hasn’t woken up after emergency open heart surgery, stay tuned! I’ve got news for you.

My name is Patrik Hutzel from intensivecarehotline.com and I have another quick tip for families in intensive care.

So, I have an email today from a reader who says,

“Hi, Patrik.

My mom had emergency open heart surgery during a transcatheter aortic valve replacement (TAVR), and now she’s on a ventilator. That was on Tuesday, it has been 3 days since the surgery. So, four days now and she’s still on the ventilator. The doctor says she isn’t ready to come off the ventilator yet. What should I do?”

Well, first off, let’s clarify the terminology, and I’m very sorry to hear about your mom’s situation. It really sounds like it is a very challenging and uncertain time for you and your family.

So, what has probably happened, your mom had undergone a very complex surgery like the transcatheter aortic valve replacement. There can be complications, and that is probably what happened, which is why they ended up opening her chest, and which is why she ended up having open heart surgery.

Initially, they wanted to do it like minimally invasive with the transcatheter aortic valve replacement. But the reality also is, when someone’s got heart surgery, the risk is fairly high. Maybe the heart stopped, maybe there was a bleeding, I don’t know it’s not clear from your email, but some complications have arisen. Maybe your mom’s heart went into an irregular rhythm, she had a cardiac arrest, who knows?

In any case, when she ended up having cardiac surgery, she probably ended up on an ECMO (Extracorporeal Membrane Oxygenation) machine or on a bypass machine that would have taken over the function of the heart and the lungs for a while, so that the heart could have been operated on. Now, therefore, it sometimes takes longer than expected for the body to heal, enough to be weaned off the ventilator.

Now, there are several reasons why it might take more time for your mom to come off the ventilator after surgery, including the recovery from the surgery. Open heart surgeries, especially those involving a valve replacement can be extremely taxing on the body, especially when open heart surgery has been performed. Basically, it’s a cut on the chest to crack the chest open; that is extremely painful, extremely taxing. So therefore, the heart, the lungs, and other body systems may need time to stabilize and that includes the kidneys.

After open heart surgery, blood pressure might go down. Your mom might have gone into an irregular heart rhythm, but that may have caused the blood pressure to go down, which could have caused kidney failure. So, that’s a consideration. You’ve got to ask about the kidney function.

Next, breathing and lung function. It’s possible that the lungs haven’t fully recovered yet, or that there is some residual fluid, inflammation or infection affecting your mom’s ability to breathe on her own. Also, keep in mind that when your mom had open heart surgery and she most likely went on a bypass machine or an ECMO machine, her lungs would have been collapsed. With the lungs collapsed, depending on how long they were collapsed for, increases the risk of atelectasis and pneumonia, and that could be one of the reasons why she hasn’t been weaned off the ventilator. One of the many reasons, like I said, hemodynamic instability, bleeding, pneumonia, chest infection, and atelectasis, these are all reasons why your mom hasn’t come out of a coma yet, and why she can’t be weaned off the ventilator yet.

Next, underlying health issues. If your mother has other health conditions such as diabetes, kidney problems, or lung issues, these can slow down the recovery process as well.

Next, weaning process. Sometimes the doctors and nurses start by lowering the amount of support the ventilator is providing and monitor closely for signs that your mom can breathe on their own. This can be a gradual process. Like I said, it is very much dependent on, is the heart in a regular rhythm or in an irregular rhythm? Is there any bleeding? Is there hemodynamic instability?

After open heart surgery, they may also measure your mom’s cardiac output, cardiac index through a PiCCO (Pulse index Continuous Cardiac Output) or through a Swan-Ganz catheter, or even by ultrasound. If that’s the case, and there’s hemodynamic instability, the ICU team will be very cautious waking your mom up until there’s hemodynamic stability. It’s good that the doctors are closely monitoring her and ensuring she’s not taking off the ventilator prematurely because doing so can lead to further complications. So, stay in contact with the medical team and the nursing team and see what the next steps are, now you have an idea of what to look for.

Maybe she’s still on vasopressors or inotropes, maybe she is on vasodilators. Vasopressors and inotropes are medications such as norepinephrine, noradrenaline, epinephrine, adrenaline, vasopressin, phenylephrine, dobutamine, dopamine, those are vasopressors. Vasodilators are drugs such as GTN (glyceryl trinitrate) or SNP (sodium nitroprusside). It’s a case of managing fine balance between blood pressure not being too high, blood pressure not being too low, and achieving a regular heart rhythm, and also maintaining kidney and other vital organs perfusion.

So, other question you could be asking is, does she have a pacemaker or pacing wires at least in the short term and are they working? Are they being used?  Patients after aortic valve replacement often come back to after surgery with temporary pacing wires in, even if it’s only for backup. So, those are questions you need to ask.

Also, what happens if they lower sedation? What happens if they lower opiates? Has it happened at all? Have they tried? Or do they want to keep her sedated to make sure she’s hemodynamically stable before they’re trying to wake her up?

Those are all questions to be considered.

Now, I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years where I’ve been consulting and advocating for families in intensive care since 2013. I can very confidently say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial.   section at intensivecarehotline.com, and you can see what our clients are saying there. You can also look up our intensivecarehotline.com podcast on our podcast section, and we’ve done some client interviews there. The clients are verifying on our interviews that we have saved their loved ones’ lives. We have helped hundreds of members and clients over the years to improve their lives instantly when they have loved ones in intensive care that are critically ill.

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

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 [email protected] with your questions.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com, click on the membership link or go 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. You also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded that are only exclusively accessible to our members. Being a member or getting one-on-one consulting and advocacy will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always.

Once again, all of that to get at intensivecarehotline.com.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have.

I also do a weekly YouTube live where I answer your questions live on a show, and you will get notification for the YouTube live if you’re a subscriber to my YouTube channel, or if you’re a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com.

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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