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Today’s article is about, ” Quick Tip for Families in Intensive Care: Mom Had Open Heart Surgery & Hasn’t Woken Up Yet After 5 Days! Still Sedated & Ventilated!

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Quick Tip for Families in Intensive Care: Mom Had Open Heart Surgery & Hasn’t Woken Up Yet After 5 Days! Still Sedated & Ventilated!

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So today’s tip is about a question from a reader and Lillian says, “My mom had major open heart surgery on Monday and didn’t wake up yet. She’s still sedated and on the ventilator. How can that happen and what’s the way forward?”

Now, that is a great question. And again, it comes back to, that the biggest challenge for families in intensive care is 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.

So Lillian, here is what you need to keep in mind. The first thing is why did your mom go into open heart surgery on Monday? Was it planned or was it unplanned? Did you go into open heart surgery because she had angina?

 She was short of breath? She needed a valve repair or a valve replacement? She had mitral regurgitation. What were the symptoms prior to open heart surgery? Was it planned weeks or months ahead? Which means it was not super urgent. Or did she go into open heart surgery because God forbid she had a cardiac arrest, a heart attack or a valve rupture, or whatever the case may be? So that’s the first question.

Then what you need to understand that during open heart surgeries, high-risk surgery, it takes usually 2 to 3 hours, sometimes longer. The longer it goes on, the higher the risk for complication or for complications. When patients have open heart surgery, most of the time, unless it’s minimally invasive, which doesn’t sound to me like it was in this situation. They go on a bypass machine.

Basically, the lungs get deflated, a bypass machine or an ECMO (Extracorporeal Membrane Oxygenation) machine is taking over the function of the lungs and the heart during open heart surgery. So that the heart is actually being stopped during open heart surgery and then it’s actually being restarted after open heart surgery. And the longer the surgery takes the higher the risk for complications. So for example, the lungs are deflated for hours on end, that increases the risk for a pneumonia to develop after open heart surgery.

That’s why patients are often ventilated well, they are ventilated after open heart surgery. But it might take time for the lungs to deflate when you do it, post-operative. Chest X-ray, you might actually see that there’s atelectasis which is a collapse of the lungs and that could develop into pneumonia. So there could be complications right away just with the development of pneumonia or atelectasis. That might be one of the complications. And that might be why your mom is still in an induced coma and sedated and ventilated.

However, other complications and probably even more common complications that happen after prolonged open heart surgery can be bleeding. It can be tension pneumothorax.  It can be arrhythmias. People going into atrial fibrillation, AFib even worse, ventricular tachycardia or ventricular fibrillation VT or VF. Those are some of the complications. Other complications that could happen is, unfortunately, I’ve seen people sustaining strokes after open heart surgery.

Other complications that I have seen are people requiring high doses of inotropes or vasopressors requiring multiple blood transfusions because of bleeding. People requiring things like tranexamic acid to stop severe bleeding. So people requiring a reopen of the chest because of bleeding or because of a tension pneumothorax.

So basically redo surgery within 24 or 48 hours to stop the bleeding or to remove tension pneumothorax. They might need another insertion of a chest drain for a tension pneumothorax or for complications like that.

So you have not shared any of the complications. But that is most likely what has happened in your mom’s situation. And that’s why she’s not waking up and why she’s still in an induced coma.

Other issues that I’ve seen happening after open heart surgery is, patients going into kidney failure. Again, especially if there’s sustained low blood pressure, because of bleeding, or other complications because of maybe the development of an infection or sepsis and then your mom might need dialysis.

So a lot of things can go wrong after open heart surgery.

By the same token, there are plenty of patients going into ICU after open heart surgery that are “straightforward” and patients can be out of ICU within 24 to 48 hours. If open heart surgery goes well, they’re going to ICU, are being warmed because they’d be coming back to the ICU pretty cold.

After prolonged surgery, they’ll be warmed up, they’ll be weaned off sedation and opiates, wean them off the ventilator, take the breathing tube out, optimize the hemodynamic status, and then send them off to the ward the day after.

So I hope that answers your question in terms of what could go wrong and most likely why your mom is still in an induced coma.

Now, if you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to support@intensivecarehotline.com with your questions.

Also have a look at our membership for families of critically ill patients in intensive care at intensivecarehotline.com and click on the membership or you can go to intensivecaresupport.org directly. There you have access to me and my team 24 hours a day in a membership area and via email and we answer all questions, intensive care related.

 I also offer one on one consulting and advocacy over the phone, via Skype, via Zoom, via WhatsApp, whichever medium works best for you. And I talk to doctors and nurses directly. I talk to you and your families directly. And especially when I talk to doctors and nurses directly, I ask all the questions you haven’t even considered asking, but you must ask them if you want to make informed decisions, have peace of mind, control, power, and influence in situations when you have a loved one in intensive care.

Now, I also represent you in family meetings with intensive care teams so that you don’t get walked all over. So that you have clinical representation and advocacy in family meetings with the intensive care team.

Now, I have worked in intensive care for over 20 years in three different countries where I have also worked as a nurse manager for over five years in intensive care. And I’ve been consulting and advocating for families in intensive care for over 10 years as part of my intensivecarehotline.com, consulting and advocacy service with getting great outcomes for our clients. You can look up our testimonial section  or you can look up some client interviews at our podcast section.

Now, we also offer medical record reviews in real-time so that you can have a second opinion in real-time and we offer medical record reviews after intensive care, if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

Now, thank you so much for watching.

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. Comment below what you want to see next or what questions and insights you have from this video and share the video with your friends and families.

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.

Kind regards,

Patrik

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