My husband had a heart attack, has been in an induced coma for over 3 weeks now& is not waking up!What do I do?Help!

Published: Mon, 04/25/16

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 last week was Part 2 of a counselling/ consulting session with one of our readers and the question last week was

My Mother is in long-term care with tracheostomy, on the ventilator and in kidney failure? When is enough enough? (PART2)

You can check out the answer to last week’s question by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer question from one of our readers and the question this week is

My husband suffered a heart attack, has been in an induced coma for over three weeks now and is not waking up! What do I do? Help!

This question from Martha formed part of a consulting/counselling session with me.

Martha writes

Hi Patrik,

My 65 year old husband suffered a major heart attack on the 16th of April and was in an induced coma for over a month. He was intubated for three weeks and now has a tracheotomy. The process of taking him off the Fentanyl and Versed(Midazolam) is taking very long.

He gets very agitated and upset almost as if having withdrawal from the drug.

This in turn makes his blood pressure and heart rate go up and they raise the drug again. Is there anything I can do to help him come through?

I try to keep him calm and as the hours pass, I see more of him come out, but then they sedate him again and the process starts all over.

They just started giving him phenobarbital to try to wean him off the versed/ Midazolam and they are transitioning to a Fentynal patch.

It's like a never ending wheel. I really want him off the meds, but don't want to hurt him. The Intensive Care team thinks he may have had a stroke, but being there with him all day I don't believe that to be the case.

My husband has no other premedical conditions.

Is there anything I can do and is this the process for weaning? I feel that the longer he is on it the more dependent he becomes and the more his body starts to weaken and shut down.

I truly appreciate your help and support. It is very difficult to watch my husband go through this. We have always tried our best not to use any meds unless absolutely necessary, so that makes it even harder to deal with.

Thank you again,

Martha

Hi Martha,

Thank you for your question and for signing up for 1:1 consulting/counselling!

I’m very sorry to hear that you and your husband are in such a difficult situation.

"Waking up" after a prolonged induced coma- one month in an induced coma is a very long time- can be very challenging especially if the medications being used are Fentanyl and Midazolam(Versed).

Fentanyl is a strong pain killer(opiate) and Midazolam(Versed) is a strong sedative and it's also a Benzodiazepine. Both drugs, Fentanyl and Midazolam(Versed) make critically ill Patients in Intensive Care addicted, especially after long usage.

In a prolonged induced coma, both drugs are drugs of choice and work well to keep a critically ill Patient in Intensive Care sedated and they also come with the side effects that I mentioned.

Therefore both drugs need to be weaned off gradually in order to wean them off slowly, so that your husband is not going through withdrawals from the drugs. The agitation that you are referring to is most likely caused by withdrawing from the Fentanyl and Midazolam(Versed).

If your husband suffered a stroke, then “waking up” and assessing your husband’s neurological condition is getting even more difficult.

In order to find out whether your husband had a stroke, they need to do a referral to a neurologist and do a CT scan of the brain.

Effective ways of managing the withdrawal process, the agitation and also the "waking up" phase are to use other drugs such as Clonidine, Dexmedetomidine (trade name Precedex), Valium(Diazepam), Haloperidol and/or Quetiapine in order to wean your husband off the Fentanyl and the Midazolam/Versed.

I have never heard of Phenobarbital given to get critically ill Patients out of an induced coma, if anything the drug keeps to keep people sedated even more. You need to check with the Intensive Care team why they are giving the Phenobarbital.

Nevertheless, even if other drugs are used, "waking up" after a prolonged induced coma is challenging and the situation you are describing is a very common situation after a prolonged induced coma in Intensive Care.

Related article/video:

HOW LONG DOES IT TAKE TO WAKE UP AFTER AN INDUCED COMA?

Besides the drug therapy, good nursing care, such as getting regular washes or showers, regular mouthcare, getting out of bed and also getting some natural daylight can often help and improve the situation.

There is such a strong emphasis on drugs(which is important), however getting good nursing care is highly underrated and it's very important too.

Get one on one phone/ Skype counselling/ consulting with Patrik

It's also important that your husband will rest at night with a good night sleep and is awake during the day. Most critically ill Patients in Intensive Care have a disturbed day and night rhythm and that contributes to the agitation.

Things that you can do are to ask for good nursing care and also find out what they are doing in order to manage the withdrawal from the Fentanyl and the Versed/Midazolam.

If you are not happy with the way things are being managed you need to get comfortable in speaking up and ask for what you want.

I can help you managing the Intensive Care team so that you get results faster, make informed decisions and get peace of mind, control, power and influence.

You may also want to find out whether your husband is enrolled in a medical research study, because often critically ill Patients are enrolled in studies that they don't know about and sometimes this impacts on which drugs they can have or can't have.

Related articles/videos:

The 5 reasons why you need to be DIFFICULT and DEMANDING when your loved one is critically ill in Intensive Care

How MEDICAL RESEARCH DOMINATES your critically ill loved one’s diagnosis and prognosis, as well as the CARE and TREATMENT your loved one IS RECEIVING or NOT RECEIVING!

Don't be shy and don't be intimidated by the "perceived power" and the "perceived authority" of the Intensive Care team.

Also, be patient. "Waking up" after a prolonged induced coma is a process and not an event. It's like switching on a light with a dimmer and not with a switch.

Give your husband the time he needs to work through this challenge in his own time.

It's often two steps forward and one step back.

I hope that helps.

Please let me know if you have any other questions.

Thank you

Take care

Patrik

There is no situation in Intensive Care that I can't help you with or that I haven't seen!