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Quick Tip for Families in Intensive Care: How Can I Get My Daughter to Wake Up After Being Intubated in Intensive Care? How Long Does It Take?

Today, I have an email from Kale who says, “Hi Patrik, I want my daughter to wake up in ICU after being intubated. How long does it take?”

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

So, the time it takes for someone to wake up after being intubated and sedated can vary widely depending on several factors, including, number one, why is your daughter intubated? 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. I can see from that email that this is exactly what Kale is dealing with because it could be a myriad of reasons why his daughter needs intubation.

So what’s intubation, anyway? Intubation is the insertion of a breathing tube into the mouth that goes into the lungs to ventilate someone artificially. They are attached to a breathing machine, a ventilator, and that could be because of a pneumonia. It could be because of an accident. It could be because of open heart surgery. It could be for lung failure. It could be for so many reasons. It could be for a severe infection, sepsis, and it’s always good that if you keep sending emails here to [email protected], that you send us emails with as much context as possible.

Let’s break down Kale’s question further. So number one, it depends on type and duration of sedation. Short-term sedation, a few hours to maybe 24 to 48 hours, people often start to wake up within 1 to 2 hours after the sedatives have been stopped.  So, what are short-term sedatives? Short-term sedatives are, generally speaking, propofol or Precedex. If you stop propofol, for example, people should wake up assuming they don’t have a brain injury or they don’t have a neurological condition. They should wake up within just a few minutes, really.

The opposite of that is long term sedation, which can take several days or more, because it can take several hours to days for the sedatives to fully clear the body, especially if the patient has been heavily sedated or has liver or kidney issues. Because with liver or kidney issues, it takes longer for the body to get rid of any excess sedatives or opiates. We come to opiates in a minute.

Opiates are painkillers, such as morphine or fentanyl, that are also most of the time used when someone is in a coma, intubated. Because without the opiates and the sedatives, patients could not tolerate to be ventilated or intubated because it’s too uncomfortable. So, it is really important that sedation and opiates can be stopped as quickly as possible.

Also, sedatives and opiates by nature, as a side effect, just have respiratory depression as a side effect. Respiratory depression basically means a patient’s natural response to breathe is inhibited.

Next, what’s the underlying medical condition? I briefly mentioned that a minute ago. So, if your daughter was intubated due to trauma, infection, cardiac arrest, brain injury, pneumonia, surgery, open heart surgery, those conditions can affect brain function and delay waking up.

Also hypoxic brain injury, for example, which is a lack of oxygen to the brain, can significantly impact the brain’s ability to regain consciousness. Then, if your daughter can’t be weaned off the ventilator because of that, then she might need a tracheostomy as the next step, but that would go too far for this video. You can just look up on our website at intensivecarehotline.com about the tracheostomies.

Next, medications still in your system. Drugs like propofol, fentanyl, midazolam/Versed, morphine, Precedex, and others accumulate over time. If your daughter has been sedated for days or weeks, her body needs time to eliminate them, and the body also needs time to rest and heal. Sometimes your daughter or any patient, for that matter, not waking up, is simply a delay in recovery. Patients recover in their own time, not according to textbook timelines.

Next, age, weight, and organ function. So, children or young adults may metabolize drugs differently. Impaired liver or kidney function can slow recovery because kidney or liver dysfunction  delay the metabolization of medications. Many patients in ICU can be in kidney or liver failure  and then, when patients are in severe kidney failure, in particular, and they end up on dialysis or hemofiltration, that will also help to eliminate sedatives and opiates.

So, when should you be concerned? If your daughter hasn’t woken up sort of within 48 to 72 hours after sedation and opiates have been stopped. The ICU team typically begins further evaluation. So, looking at neurological functions such as CT (Computed Tomography) scan of the brain, MRI (Magnetic Resonance Imaging) scan of the brain, EEG (electroencephalogram), pathology like lab values, oxygen levels during the event that led to intubation. Was there potentially a hypoxic event during intubation?

I’ve also written and made a video, “How to wean a critically ill patient off the ventilator and the breathing tube?” that I’ll link towards in the written version of this blog. I encourage you to check that one out as the next step.

Also, keep in mind. Extubation, the removal of the breathing tube is almost impossible to be achieved without waking up. Like I said, one of the next steps might be if your daughter can’t wake up at all, for whatever reason, does she need a tracheostomy? But like I said, that would go too far in this video, and I’ve got plenty of other videos about what a tracheostomy is.

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 critical care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. Whether it’s in my clinical practice or here at intensivecarehotline.com, I’ve probably looked after thousands of critically ill patients and their families over the years. So ,I have a wide experience to draw from, there’s probably no situation that I haven’t seen in ICU.

I can very confidently say that we have saved many lives for our clients in intensive care. You can verify that if you go to our intensivecarehotline.com testimonial section at intensivecarehotline.com or if you go to intensivecarehotline.com podcast section where we have done client interview because our advice is absolutely life changing. With all of that said, we help families in intensive care to improve their lives instantly so they can make informed decisions, have peace of mind, control, power and influence, making sure the loved ones in intensive care get best care and treatment, always.

You can join a growing number of members and clients that we have helped over the years. We’ve helped hundreds and hundreds of members and clients over the years, once again, to improve their lives instantly in intensive care, making sure their loved ones get the best care and treatment always.

That’s 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 can’t afford to get wrong. I also talk to doctors and nurses directly on your behalf or with you or I set you up with the right questions. 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.

We also have a membership for families of critically ill patients in intensive care. 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 videos and 21 e-books that only are exclusively accessible to our members. All of that 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.

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.

If you like my videos, subscribe to 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. You will get notification for the YouTube live if you are a subscriber to my YouTube channel, or if you are 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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