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My name is Patrik Hutzel from intensivecarehotline.com, where we instantly improve the lives for families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always, even if you’re not a doctor or a nurse in intensive care.

So, today’s question comes from Gleiciane, who writes:

“Hi Patrik,

My husband had open-heart surgery with complications. He is not waking up. He needs 100% of oxygen, and now he’s bleeding from the stomach. I am so scared. What are the chances of survival for a person in an induced coma? Thank you.

From, Gleiciane.”

Hi Gleiciane, I’m so sorry to hear about your husband’s situation. Open heart surgery is a major procedure, and complications are unfortunately quite common in intensive care afterwards. So, let’s break this down, what might be happening, why it’s happening, and what treatment options are available.

1. Induced coma after open-heart surgery

It is rather common for patients to remain in an induced coma or be heavily sedated after open-heart surgery at least for 24 hours. Sedation and opiates help to protect the heart, brain, and lungs during recovery.

Also, keep in mind that open-heart surgery, the chest is cracked open, that is incredibly painful. So of course, initially the first few hours after open-heart surgery, high doses of opiates and sedatives are needed in order to make sure patient comfort and safety is ensured.

If all goes well after 24 hours, the patient can be woken up, can be warmed up because they’re usually quite cold after prolonged surgery, and therefore, the patient once they’re warmed up, no complications, then you can warm them up, wake them up, extubate them, take them off the ventilator and the breathing tube. That is the ideal scenario.

However, if your husband is not waking up as expected, it’s important that the ICU team investigates potential causes such as hypoxic brain injury or cardiac arrest during or after surgery, stroke or seizure activity, medication overdose or prolonged sedation and opiates, ICU acquired weakness or delirium.

The fact that he’s needing 100% of oxygen means his lungs are not functioning properly, possibly due to pneumonia, fluid overload, or ARDS, also known as acute respiratory distress syndrome. ARDS is also known as lung failure.

Now, if they want to investigate a hypoxic brain injury or a stroke or any other neurological complications, your husband needs a MRI (Magnetic Resonance Imaging) scan of the brain, a CT (Computed Tomography) scan of the brain, or an EEG (electroencephalogram) or a combination of all of the above. He also would need some input from a neurologist.

Also, why would he end up with a pneumonia or ARDS within such a short period of time? When patients are having open-heart surgery, most of the time they’re ending up on ECMO (Extracorporeal Membrane Oxygenation) so that the lungs can be deflated during open-heart surgery so that the surgeon can access the heart. It’s quite a complex procedure.

During that period of time, the lungs are deflated, and after surgery, the lungs are inflated again. But the risk that the lungs or parts of the lungs collapse while the patient is on a bypass machine, i.e., ECMO, is quite high, and that’s when complications such as pneumonia can occur after open-heart surgery.

So let’s look at the next point. What are common complications after open-heart surgery? Here are some of the most frequent and dangerous complications we see in intensive care after open-heart surgery:

1. Cardiac tamponade

This is bleeding into the sac around the heart, the pericardium, which puts pressure on the heart and can stop it from pumping properly. It needs urgent surgical drainage because otherwise the patient can go into cardiac arrest because the heart will stop beating because of the pressure in the pericardium.

2. Arrhythmias

Irregular heart rhythms such as atrial fibrillation or ventricular tachycardia or even ventricular fibrillation. They may require antiarrhythmic medication or even pacing defibrillation. Common antiarrhythmic medications are amiodarone, Digoxin, for example, but also, lidocaine at times.

3. Pneumonia or chest infections

Very common due to prolonged ventilation, needs antibiotics, physiotherapy, and careful suctioning.

4. Bleeding

Both surgical bleeding and internal bleeding like in your husband’s stomach bleeding. A stomach bleed after open-heart surgeries, not as common. But a stomach bleed in ICU, it can be quite common, especially for long-term ICU patients. It’s a stress response.

Maybe your husband had gastric ulcers or stomach ulcers before cardiac surgery. Treatment options here are pantoprazole, for example, pantoprazole infusion. Another complication could be cardiac arrest, sometimes the result of arrhythmias or tamponade, immediate resuscitation is crucial.

Let’s look at GI bleeding or stomach bleeding after open-heart surgery. The stomach bleeding your husband is experiencing is most likely due to stress ulcers caused by the stress of critical illness, but once again, maybe your husband had some gastric or stomach ulcers even before surgery.

5. Blood thinning

Medications such as aspirin, warfarin, heparin, clopidogrel, commonly used after heart surgery, and once again, maybe he was on them beforehand.

6. Liver dysfunction or clotting problems in general

Treatment options include stopping or adjusting blood thinners, IV proton pump inhibitors such as pantoprazole or omeprazole, blood transfusions if hemoglobin drops, but also, platelets, fresh frozen plasma would be other blood transfusions that can be given.

Endoscopy to identify and stop the bleeding sources. In rare cases, angiography or surgery to control ongoing bleeding.

7. Infusions

Tranexamic acid, also known as TXA can be treatment options.

Let’s now look at the chances of survival. The chances of survival depend on how quickly and effectively the ICU team identifies and manages all complications.

If the causes of respiratory failure, GI bleeding, or heart instability are treated promptly and aggressively, survival chances increase significantly. However, persistent need for 100% oxygen is a sign of severe lung involvement and must be addressed quickly, sometimes with advanced treatments such as prone positioning, nitric oxide, epoprostenol, nebulizers, or even ECMO in severe cases.

The ICU team should also perform a neurological assessment, like I said before, CT scan of the brain, EEG, MRI scan of the brain, or sedation hold to determine brain function if he’s still not waking up.

Next, what can you do right now? You are your husband’s best advocate. The best way to influence his care and treatment is to ask the right questions and ensure the ICU team is not giving up prematurely.

So, what questions should you be asking the ICU team in a situation like that?

1. Have you ruled out cardiac tamponade or internal bleeding around the heart?
2. What is being done to manage the GI bleed? Has he had an endoscopy yet?
3. Why does he need 100% oxygen? Is it ARDS, pneumonia, or fluid overload?
4. Has the team considered ECMO if his oxygen levels remain critical?
5. Have you done a CT brain scan or EEG or an MRI scan of the brain to assess brain activity?
6. What are his current infection markers, CRP (C-reactive protein), white cell count, temperature?
7. What are you doing to optimize heart function medications, pacing, other support devices? Is he on inotropes, vasopressors, or vasodilators such as norepinephrine, noradrenaline, epinephrine, adrenaline, dobutamine, dopamine, milrinone, also GTN or sodium nitroprusside?
8. What’s the plan to reduce sedation and assess neurological recovery? What’s the plan to reduce opiates and painkillers to assess neurological recovery?
9. What are you doing to protect the stomach from further bleeding, i.e. the PPIs, the proton pump inhibitors?
10. What’s the overall short and long-term plan for his recovery and weaning off life support?

In summary, your husband’s situation is critical, but certainly not hopeless. Open-heart surgery complications are common, but with the right interventions, stopping the bleed, optimizing oxygenation, treating infections, and supporting the heart, many patients do survive and recover.

You need to stay involved, ask the right questions, and ensure the ICU team leaves no stone unturned. If you want one on one guidance and consulting and advocacy so you can ask the right questions and make informed decisions, contact us here at intensivecarehotline.com for a confidential consultation.

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 in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.

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.

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 best care and treatment always. 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.

That’s why I do one on one consulting and advocacy over the phone, Zoom, 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 cannot afford to get wrong. 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 if in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

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, if you click on the membership link, or if you 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. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

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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.