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

My 59 year old Dad is in ICU after cardiac arrest! He had to be resuscitated for 18 minutes, will he have brain damage?

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 another question from one of our readers and the question this week is

My uncle is in Multi-organ failure after three weeks in ICU! He's ventilated with a trachea, on Haemodialysis and he's not waking up! Everything seems to go wrong, what do we need to do?

This question is an excerpt from a 1:1 phone/Skype counselling session

Melanie describes her uncle's situation in Intensive Care as follows

Hi Patrik,

my uncle was taken into ICU as we found him dazed and confused on the 20th May so it's nearly been three weeks now.

He had sepsis then multiple organ failure, he was sedated on the first day then left under sedation for majority of the time during the three weeks.

With him going into multi-organ failure his kidneys failed and he had to go on to Haemodialysis on and off.

He also was on the ventilator with the breathing tube and had sedation stopped.

But after four days of no signs of him waking up and being alert after sedation was stopped, but him still being restless and agitated and not breathing well on the ventilator, he had to be re-sedated and taken for a full body CT scan.

His CT scans were all normal so he had a tracheostomy fitted and again had sedation stopped.

After that he has been opening his eyes but looks like he's seeing things that aren't there and we are no good at lip reading and he has no strength to write things down and he's not really responsive.

He keeps moving his jaw from side to side. His kidneys are now working, he is only on 30% oxygen from the ventilator but he has a constant high temperature up to 40C (104F) and his heart rate sometimes can go as high as 186 beats per minute.

The staff in ICU have given up trying to find out why nothing even showed up on the CT scan.

He is a very overweight man so I guess this goes against him as they keep telling me, but I would really like to know what to do and I'm so worried that he has lost his mind because he stares up at the ceiling and seems to move he's jaw from side to side.

It's currently day 5 with no sedation and he started following a few of the nurses and our family’s commands.

We are wondering if this is withdrawal from sedation and sometimes he obeys command then he goes back to sleep, 2 seconds later he comes round and stares into space!

It's been 2 days now and no sedation, how long do you think it can take for him to wake up and recover and hopefully get off the ventilator and the tracheostomy?

Every time we feel we get somewhere with him something else seems to go wrong, now they are talking about doing a lumbar puncture tomorrow morning.

Any advice would be greatly appreciated.

Please help!

Many thanks

Melanie

Hi Melanie,

I'm sorry to hear about the difficult situation that you and your uncle are dealing with in ICU.

It’s great to see that you are taking action though and it’s great to see that you are seeking help through my 1:1 phone/Skype counselling and consulting service!

Multi organ failure is always challenging and is often a cause of sepsis. Sepsis is a severe infection that causes all major organs to fail, including the kidneys.

You are mentioning that "Every time we feel we get somewhere with him something else seems to go wrong" and I can see how that might give you a pessimistic outlook.

The reality in Intensive Care when it comes to Sepsis and MOF (Multi organ failure) is that it can be a long journey and that it's often two steps forward and one step back.

Three weeks in ICU after MOF/Sepsis may seem like an eternity for you and your family, however in the bigger scheme of things and in Intensive Care terms it's not a very long time and it sounds to me like the Intensive Care team hasn't really determined the cause of the MOF/ Sepsis. This is most likely why they want to do a lumbar puncture to

• find out whether CSF (fluids in the spine and the brain) may have been a cause leading to Sepsis, I.e. Meningitis

• If that's the case it would also explain why your uncle hasn't "woken up", as the brain might be affected through things like Meningitis and/or increased brain pressures.

Therefore there is a high chance that your uncle simply hasn’t woken up because he’s still going through withdrawal from the sedation and he’s taking his time to “wake up” after the induced coma.

However, even though it may feel like a lifetime for you and your family, "not waking up" after three weeks in ICU, in an induced coma with MOF is not a very long time at all and sometimes critically ill Patients in Intensive Care in an induced coma, with MOF, on Dialysis etc... may be in ICU for weeks or sometimes months to come.

You have mentioned that your uncle has been on sedation and in an induced coma for most of the time, therefore given his high level of critical illness, it doesn't surprise me that your uncle hasn't woken up yet.

Related articles/videos:

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

• AFTER WEANING OFF A VENTILATOR IS IT NORMAL TO BE CONFUSED?

Multi-organ failure and sepsis is life threatening on every level, therefore for now, look at the positives and look at the situation that your uncle is alive!

Many critically ill Patients in Intensive Care will die with Multi-organ failure!

It also sounds to me like the Intensive Care Unit is trying their best to save your critically ill uncle’s life!

Many Intensive Care Units would give up early on with all the challenges your uncle is facing, therefore it sounds to me like you, your family and your uncle are in the right place at the right time.

Just by what you are describing, they seem to have taken all the right steps by trying to wake him up after the induced coma and when he wouldn't "wake up" they were doing the full-body CT scan and then they were doing the tracheostomy!

In the meantime they were giving him Dialysis for his kidney failure twice to take over the function of his failing kidneys!

Related article/video

• Why your critically ill loved one might need Dialysis (Kidney machine) or Haemofiltration for Kidney Failure (Renal Failure) and is having a Dialysis machine attached to them!

So be patient, get as much info as possible, keep asking questions and keep educating yourself! Most of all don't panic and keep educating yourself on the topic and the issues.

Also, research suggests that in 1/3 of all cases of Sepsis no cause can be found! Furthermore, up to 40% of ICU Patients with sepsis may die, therefore with your uncle being alive after three weeks in ICU you should keep looking at the positives!

I have been consulting a client while back in a different but somewhat similar situation where the client’s Mum was in ICU for three or four months and the client at the time thought that her Mum would die from her severe critical illness.

My client and her Mum went through many ups and downs during her stay in ICU, including Sepsis, MOF after Lung failure/ARDS, ECMO, including going through delirium, ICU psychosis and not "waking up" for many weeks.

Reading through my other client's case study might be helpful to give you more perspective around the topic of sepsis and "waking up" in ICU after prolonged and severe critical illness.

Therefore, be patient.

Related articles/videos:

• My Mum has been in ICU for three weeks now and she is on ECMO for ARDS! Will she survive?

I know this is easier said than done, but please stay with your uncle for now and stay strong. Give him time.

Hopefully the Intensive Care team can rule out Meningitis or any other brain related issues that may prevent your uncle from not "waking up".

Once they have ruled out any brain related issues such as Meningitis and/or raised brain pressures there is a very high chance that your uncle is "just" withdrawing from the medications he has had during the induced coma.

On top of that his body would be considerably weakened after the Sepsis and MOF.

This combination is a recipe for not "waking up" quickly, ICU delirium, confusion, agitation and “fighting” the ventilator. I have seen this over and over again!

It’s really about having perspective in this situation Melanie and it’s really about letting you know that situations like this occur in ICU and people do survive this ordeal. There is no guarantee of course, however there is improvement and I believe that just by what you are describing they are doing all the right things and they are not giving up!

Furthermore, what you haven't mentioned is that with Sepsis/MOF your uncle would have been or may still be on Inotropes.

Inotropes are intravenous drugs given via a central line (CVC) to increase a low blood pressure and to improve the contractility of the heart.

With Sepsis and MOF the heart would be affected as well because of septic shock and one of the signs is usually a low blood pressure that can be life threatening as well, therefore your uncle's heart would have been or still is on Inotropes.

Therefore, give your uncle time! Time is often the ultimate healer!

If they can’t find a cause for the Sepsis, let your uncle "wake up" in his own time and once he's more alert, then they can focus on getting him off the ventilator and the tracheostomy!

Related article/video:

• TRACHEOSTOMY AND WEANING OFF THE VENTILATOR IN INTENSIVE CARE, HOW LONG CAN IT TAKE?

Take one step at the time and take it day by day.

Again being patient and persistent is one of your biggest assets in this challenge!

I think you and your family are doing great by trying to support your uncle through this!

Give me an update when there are news or if you need anything in the meantime please let me know and we can have another chat!

Take care

​​​​​​​

Your friend

Patrik Hutzel

PS: I only have one slot left for counselling/consulting left for this weekend, as I'm fully booked otherwise. Let me know if you want the one slot left by hitting reply to this email or by calling me on one of the numbers below!