Hi, it’s 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, 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 answered another question from our readers and the question was
How Does Prone Positioning Help my Dad with Pneumonia Recover in the ICU?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients Eric, as part of my 1:1 consulting and advocacy service! Eric’s dad is with a breathing tube and is on a ventilator. Eric is asking when will his dad wake up from an induced coma if he is heavily sedated in the ICU.
When will my Dad Wake up from an Induced Coma if He is Heavily Sedated in the ICU?
Eric: Do you think they’ll let us come and see him again soon?
Nurse: I’m really not so sure about that. I think at the moment, from what I’ve heard, it’s still not possible.
Eric: Okay. Would you tell my dad night-night? Would you tell him night-night?
Nurse: Oh, okay. I will do that. What was your name, honey? I forgot to ask it.
Eric: Eric. It’s his son.
Nurse: Oh, yeah.
Eric: And so I’m next of kin. Yeah.
Nurse: Yeah. Yeah. I’ll let him know that you phoned in your nurse, and that you phoned good night.
Eric: Yeah. Oh, thank you for your time.
Nurse: You’re very welcome.
Patrik: Thank you so much.
Nurse: Okay.
Patrik: Have a good shift. Thank you so much. Bye. Bye.
Nurse: Bye. Good night. Have a good night.
Eric: Yeah. Will do. Bye.
Nurse: Thanks. And goodbye.
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Eric: Hello?
Patrik: Yes. Can you hear me?
Eric: Yes.
Patrik: Can you hear me?
Eric: Yeah. And that was really good, because I wouldn’t have been able to think of all those questions.
Patrik: Yes.
Eric: And you did it right, in a brief way.
Patrik: Yes. Let’s break this down. So…
Eric: Yeah.
Patrik: And I’ll start sort of from head to toe. He’s heavily sedated at the moment. Which means he’s in an induced coma, and they’re using a lot of sedation there. And he is in deep asleep. You might have heard me ask, when I said, “Is he paralyzed?” As well. What often happens is… Not often, but sometimes what happens, is they sedate people, but they’re still not sedated enough to tolerate the ventilator, and this is what’s happened in your dad’s situation. So he’s sedated, but he’s also paralyzed. With medication. Paralyzed with medications. So, I would also think that’s probably part of why the proning didn’t work. I should have asked that, but..
Eric: Right.
Patrik: It’s an indicator to me that probably they tried to paralyze him, it didn’t work, and that’s probably one of the reasons why proning didn’t work.
Eric: Right. They just turned him back.
Patrik: They’ve turned his back. That’s right. He’s on 90% oxygen; that’s a lot.
Eric: Yes.
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Patrik: The air that you and I breathe in is 21% oxygen. So he’s on 90% of oxygen. They ideally need to get that down. And one way to get it down, often, is by proning. You might have also heard me ask, I did ask them, “Has he been diagnosed with ARDS,” and he is denying that, which is good. The reason I’ve asked whether he’s been diagnosed with ARDS is, a lot of patients at the moment, they get COVID,
they end up in ICU with COVID pneumonia, and then they go into ARDS. And ARDS is basically lung failure.
Eric: Yeah.
Patrik: But he denied that, which is good. Obviously, he needs a lot of support from the ventilator at the moment, which is obviously the biggest concern, probably. And because he is so deeply sedated, I asked him, “Is he on inotropes?” And you might have heard him saying he’s on adrenaline and noradrenaline. And basically what that means is, his blood pressure is low. And it’s low to a point where they need to support his blood pressure with medication. So if they weren’t giving those medications, adrenaline and noradrenaline, he probably could die.
Eric: Yes. He’d be really in danger. Yeah.
Patrik: Right. He would be really in danger. And that’s part of him being in ICU. So, you know, they’re doing all the right things, as far as I can see. Then, moving down, so, he’s got the nasogastric feeds. He’s absorbing them, which is a question I asked. The kidneys are working, which is important. He
doesn’t need a lot of suctioning, from what I understand.
Eric: Yeah. There’s not a lot of secretion in the lungs, yeah.
Patrik: Right. Which can be a good or a bad thing, because sometimes it’s good, especially if he’s got an infection, if it comes out.
Eric: Yeah. Because they said he had a bit of fluid on his lung yesterday, as well.
Patrik: Right. No surprises there. Then I did ask him about blood results. He says that they’re okay. The blood gases are a
little bit acidotic. What that means is, his CO2, his carbon dioxide, is high. His oxygen levels in the blood is okay. But bear in mind, that’s on 90% of oxygen.
Eric: Yeah. Whereas they got him to… I think they said they got him to about 80% last night. So it’s gotten thicker, doesn’t it? And so that’s quite…
Patrik: Yeah, that’s the biggest… Out of all of these, my biggest concern is oxygen at 90%.
Eric: Yeah.
Patrik: That’s my biggest concern. And it would be their biggest concern too.
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Eric: Yeah. And that’s what they were saying to me. So, I don’t know. I’m still in this situation. I don’t know if I’m going to have a dad, or my dad’s going to die. You know, it’s a…
Patrik: Look. There’s no guarantees, of course, but what I will say is this, Eric, roughly 90% of ICU patients survive. Okay, that’s…
Eric: Yeah. That’s a big amount.
Patrik: And that’s a big amount. So, at this particular point in time, yes, he’s hanging in the balance… But he’s alive. And as far as I can see, there is not..
Eric: There’s hope.
Patrik: There is hope. And also, there’s nothing suggesting, at the moment, that they’re not doing everything they can. Now, that might change, if he’s not improving. But at the moment, there’s no indication for that.
Eric: I think what concerns me is you know the sedation what they give them? The sedation where it can have a side effect where it can make you feel where you’re drowning, or you got water in your lungs? I think, is it the midazolam? I mean, they’ll probably be giving strong amounts, but there’s been a
lot of people in the country where they’ve been overdosing people on midazolam. And saying it’s COVID. And obviously, if you have a lot of it, that really doesn’t help you with your breathing. I think that’s what I get concerned about.
Patrik: And rightly so. The midazolam, the propofol, and the remifentanyl, the quicker they can get rid of it, the better. With what he described there, I can’t see that going anytime soon. The reason I’m saying that is, so, they’re giving the propofol, they’re giving the midazolam, and they’re giving
the remifentanil. So he’s got a very long way to go there at the moment, unfortunately. There are some damaging side effects from a long-term induced coma, for sure. Unfortunately. I can’t sugarcoat that. And, so, the quicker he can come out from an induced coma, the better it is. But at the moment, he is far away from that.
Eric: Yeah. Because he’s got to get the oxygen level a lot lower down.
Patrik: Yes, yes. Absolutely. That is priority at the moment.
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Eric: And it’s like you’re damned if you do or don’t. And they’ve given him sedatives because he needs them, but then I don’t know if they’re the right ones to use with breathing issues.
Patrik: The problem there is, though, that, despite people being sedated now for decades, midazolam and propofol are the standard sedation in ICU. There’s not much else. There’s not much else, unfortunately. And I wish there was something else, but I have not come across something else.
Eric: Yeah. I know.
Patrik: Yeah. It’s just terrible.
Eric: Yeah.
Patrik: But the good news was, this nurse seemed to be really nice, and he was answering questions. Now, I will tell you, when… If we call them another time, I would not necessarily say, “Who was the first person we spoke to? Was that the nurse in charge?”
Eric: Yeah. I think, yes, it was somebody in the office.
Patrik: Yeah. I would not necessarily say to them that I am on the phone. You can do that once we are through to the bedside nurse.
Eric: Oh, yeah, they can be protective.
Patrik: Yeah. Because they can be protective. So I would not make a big fuss about it. I would just tell the nurse, like the bedside nurse, “Oh, yeah, look, by the way, I’ve got Patrik on the phone,” and go like that. Because there might come a point, if he is not improving, God forbid, they may want to
protect their turf, and they want to make decisions, and they do not want to have too many people knowing and understanding what’s happening. So, that’s why I would keep a very low profile there.
Eric: Yeah, you’re right. So, what I could do is, we’ll have a look tomorrow, we’ll look, probably, or…
Patrik: Yeah, you can look. You can do that. We’ve still got time. We can do the same again tomorrow. We can do the same again tomorrow, for sure. Or the day after. Whenever you think it’s necessary. It’s up to you.
Eric: Yeah. I’ll just play it by ear.
Patrik: Yeah. Exactly. Just play it by ear. But, yeah, I would not tell the nurse in charge, “Oh, yeah, I’ve got Patrik on the phone.” Just get through to the bedside nurse, because they know what’s going on.
Eric: Yeah. Sorry about it. Yeah.
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Patrik: No. I’m just… I thought the number would get us directly into the room.
Eric: Yeah. They use, actually, a mobile phone, in the ward. But I think that was, a bit, really, for the patients. But one could forget that you will get through to the nurses, who are on the ward. So I could try that little bit next time.
Patrik: Sure, sure. Yeah. Look, the most important thing is that he was nice, he was cooperative, and we got all the answers. Now you also have a better idea what to look for, and what to ask. You know?
Eric: So, yeah. It does. It’s actually really good. And it’s like, when you said about when to take… If they try and take the breathing
tube out of him. What happens if you’re still struggling to breathe? Should I be getting over there to when they’re wanting to get him out of the coma? Is that a question to ask?
Patrik: I’ll tell you what will happen if he continues to struggle to breathe. Let’s just say he comes out of the coma, and he still needs the ventilator. The next step would probably be a tracheostomy. Have you heard of a tracheostomy?
Eric: I’ve been reading up on your website. Yeah.
Patrik: Right.
Eric: What do… Yeah. Do you think it would still… For in Dad’s position?
Patrik: Not yet. And they wouldn’t. It wouldn’t be safe to do a tracheostomy on 90% of oxygen. Those oxygen requirements would have to come down considerably. Because, at the moment, the risk of doing a tracheostomy would be too high, for things to go wrong. Because it’s a procedure. It’s a sort of a
small operation.
Eric: Yes, yeah.
Patrik: So, it’s nowhere near on the cards. Now, let’s just say, best-case scenario that I can predict is, they can wean down the oxygen. They can slowly get him out of the induced coma. And then he may be too weak to get off the ventilator when he comes out of the induced coma. That could be a scenario. And if
he is too weak to get off the ventilator because of the induced coma, and because of everything he’s going through, then a tracheostomy would be the next step. But it’s too early to say where this is going… you know, a tracheostomy is only really an option once oxygen is down to 40% or less.
Eric: Yes. Yeah. I just hope… I hope there’s a miracle, Patrik. Well, I’m a Christian, and my dad raised me that. I just hope that if he’s meant to go, that God will call him up, and if he’s meant to be with me…
Patrik: Sure.
Eric: That he called up, and I think… It’s a prayer, as well, then.
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Patrik: It’s a prayer. And unfortunately, Eric, let’s just say your dad pulls through. There won’t be a quick recovery.
Eric: No, it would take weeks, the oxygen would take him.
Patrik: Take weeks. Yep, yeah. So, unfortunately, there won’t be a quick fix.
Eric: Yeah… yeah, that’s understandable. I mean, one thing… because my dad said, “Would you care for me, Eric?” And I said, “Of course I will!” I said, “That’s no problem.”
Patrik: Right. Look, and it’s so hard to predict, from this point onwards. It’s so hard to predict where it’s going.
Eric: Yeah.
Patrik: I tell you what I can see, going forward. Hopefully he can improve from there. But the biggest challenge will probably be the ICU being negative.
Eric: Yes. He has been really but quite a few terms. So it’s been a little bit… Yeah.
Patrik: So, that will be one of your biggest challenges. Because, for families, it’s not even in the realm of possibility to give up. For them, giving up is something they’re trying to push onto people day by day.
Eric: Yes. And I don’t want to be… yeah, and I don’t want to deal with that. Because you’re just so right, yeah. There’s an agenda, doesn’t there?
Patrik: There’s an agenda. There’s an agenda of freeing up beds. They’re so busy.
Eric: Yeah.
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Patrik: They have another patient in there in no time.
Eric: Yeah. To be honest, though, Patrik, they keep saying about, “Oh, there’s COVID,” and there was quite a few spare beds that we noticed, or whether we whisked up to..
Patrik: I’ll give you my take on that. Empty beds doesn’t necessarily mean there is no work, there are no patients. Empty beds could mean no staff.
Eric: Oh, right, yeah.
Patrik: Right. So..
Eric: Because they’ve been short on the staff. They did say that. Yeah.
Patrik: Right. So, it could mean that simply there is… Maybe you are in an area where there is not a lot of COVID. But empty beds could simply mean no staff.
Eric: Yeah.
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Patrik: How big is that ICU? Do you know? How many beds?
Eric: There’s four beds in each room. There’s two rooms. So there’s four beds. The ward with Dad was only four. Its four beds. And that was the one with the electric ventilator that he gets, with the coma. And there’s four beds in there. And I think that was full up, what my dad was in. And there’s the room
what my dad was in.
Patrik: That’s really low. Sure. Sure.
Eric: Yeah. They have got another COVID ward. And I think you go on that if you just need to be on oxygen. We knew somebody who went on it, and they was in there for about a week, just getting the normal oxygen.
Patrik: Right. Look, it also sounds to me that COVID is real, where they’d see or indicate, but I also think it’s getting milder. I think. Which is normal for a pandemic, that, as time progresses, it’ll get milder.
Eric: Yeah. Because if someone’s in your area, and…
Patrik: Find them.
Eric: And that seems real for someone to want it. Yeah.
Patrik: Exactly. So that’s what it looks like, that, yes, COVID is here, but there’s fewer hospitalizations, probably, compared to a year ago. Because the strain keeps changing.
Eric: Yeah.
Patrik: So that could be another reason why there’s fewer beds occupied. But I do believe that most hospitals, whether it’s here or anywhere else, have no staff. The nurses have burned out.
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Eric: Yeah, it’s… Yeah. I think people are getting stressed out. And I think as well, with the vaccines, just that they start making outlandish to all the staff.
Patrik: Oh, it’s the same here.
Eric: They all want it as well. They’ll end up losing more people.
Patrik: They’ll end up losing more people. They mandated the vaccine here, for healthcare workers, and the industry is losing people, because not everybody wants to get vaccinated.
Eric: Yeah. It’s like an eye-opener. Now I’ve got COVID, I think I should have the antibodies, really, now.
Patrik: You should have, yeah.
Eric: Do you think it’s worth having the antibody tests done?
Patrik: I think its worth, for you, having the antibody tests done. I mean, I am not in the business of telling people whether they should or shouldn’t have the vaccine. I had the vaccine.
The 1:1 consulting session will continue in next week’s episode.
