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
My 54 year old husband went into cardiac arrest and he sustained an anoxic brain injury! At first he wasn't "waking up" but now he’s improving, what is next?
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 we are getting quite frequently from our readers and the question this week is
What are the side effects of an induced coma?
Many people who come and visit our website come here because they have a loved one critically ill
in Intensive Care and their loved ones most of the time are in an induced coma.
Besides our readers asking other questions related to induced coma such as
They also want to know about the side effects of an induced coma.
And of course you do want to know about it.
When your loved one first gets admitted to Intensive Care and is in an induced coma and on a ventilator/breathing machine for their critical illness, families often tell us that they don’t recognise their
critically ill loved one anymore.
The drastic changes that occur when going from a healthy person to a person who’s critically ill and in an induced coma are rather confronting and people who come to our website want to know about the side effects of an induced coma.
Side effects of an induced coma
Side effects of an
induced coma can vary slightly and it all depends on the length of the induced coma and it also depends on the drugs being used.
A short-term induced coma can have little to no side effects and a short-term induced coma is usually anything less than 72 hours.
Side effects of an induced coma may also vary depending on age as well as any existing pre-medical
history.
I also need to point out that this blog post only addresses side effects of an induced coma in Intensive Care and it doesn’t look at long-term side effects of a pro-longed induced coma that may manifest outside of Intensive Care.
Therefore let’s get back to our original question and look at answers in detail.
So, any induced coma >72
hours will usually have some common side effects.
Again, it all depends on age as well as existing pre-medical history.
For example, a 82 year old man or woman having open heart surgery and being induced into a coma might take longer to “wake up” if they have complications.
I.e. if there are post-operative complications such as bleeding,
hemodynamic instability etc... and they are staying in a coma for >7 days you’d expect side effects such as
- Immobility
- Skin sensitivity including increased risk to develop pressure sores due to immobility
- Nightmares and visual
disturbances
- Confusion
- Delirium
- Reduced muscle tone and de-conditioning
- Dizziness
- Nausea
- Vomiting
- Headaches
- Constipation
- Addiction to sedative drugs such as Midazolam
- Addiction to Opioid drugs such as Morphine and/or Fentanyl
- Inability to be weaned off the ventilator with increased likelihood for tracheostomy
Related article/video:
Most critically ill Patients in Intensive Care who come out of an induced coma are not in a position to get out of bed and get mobilised quickly.
It takes time to “wake up” and “waking up” is often a gradual process and doesn’t happen straight away.
Other side effects of an induced coma are also dependent on the drugs being used.
For example, in an induced coma, sedatives such as Propofol(Diprivan) or Midazolam(Versed) are being used to put a Patient asleep.
Furthermore, Opioid drugs(=strong pain killers) such as Morphine or Fentanyl are being used as well to induce people into a coma.
Sedatives and Opioid drugs(=strong pain killers) have side effects such as
- Hypotension(=low blood pressure), mainly in Propofol
- Respiratory depression/hypoventilation
- Addiction, mainly in Midazolam(Versed), Morphine and Fentanyl
Therefore,
especially when Midazolam(Versed) and/or Morphine/Fentanyl are being used long-term, a gradual reduction is recommended as withdrawal symptoms may be present needing to be managed.
Withdrawal from sedatives and/or opioids can be managed by slowly reducing them as well as by using Clonidine.
Related
Paralysing agents
Sometimes in an induced coma critically ill Patients also require to be temporarily paralysed.
This is due the necessity of sometimes having to completely paralyse a critically ill Patient.
In some cases,
despite heavy sedation and strong Opioid use, critically ill Patients are unable to be ventilated during the induced coma and therefore they may require muscle relaxants/paralysing agents to become completely immobile and tolerate ventilation therapy.
This should be a last resort, even though muscle paralysis is temporarily used when Patients are intubated(=insertion of a breathing tube) and induced into a coma.
It’s simply that sometimes, and induced coma with sedation such as Propofol(Diprivan) or Midazolam, as well as Morphine/ Fentanyl may not be sufficient for a critically ill Patient to tolerate all the interventions that are needed for therapy.
Sometimes, complete paralysis is also necessary to reduce oxygen consumption in an induced coma, as well as reduce intracranial pressures in the brain after traumatic brain injury.
Sometimes muscle paralysis is also necessary when critically ill Patients are being proned, on ECMO, receiving therapeutic hypothermia or are having Asthma or COPD because of the stiffness of the lungs and the inability to ventilate.
As a rule of thumb, paralysing a critically ill Patient should be minimised as much as possible due to the risk factors such as the complete immobility.
The longer a critically ill Patient is paralysed, sedated and ventilated, the longer it usually takes to “wake up” after the induced coma and the longer it takes to be weaned off the ventilator and have the breathing tube removed.
ICU Psychosis
Other issues and side effects after a prolonged induced coma and heavy use of sedatives such as Propofol(Diprivan), Midazolam(Versed) and Opioids such as Morphine and Fentanyl are what is often being referred to as ICU Psychosis and/or ICU delirium.
ICU Psychosis and/or ICU delirium is a side effect of a prolonged induced coma and it’s
also a side effect of stress, sleep deprivation, continuous noise, continuous light levels, lack of orientation, pain and cumulative sedation and analgesia(=pain relief).
Symptoms of an ICU psychosis are often showing up as
- extreme excitement
- anxiety
- Restlessness
- hearing voices
- clouding of consciousness
- hallucinations
- nightmares
- paranoia
- Disorientation
- Agitation
- delusions
- abnormal behaviour
- fluctuating level of consciousness which include aggressive or passive behavior.
In short, patients become temporarily psychotic. The symptoms vary greatly from Patient to Patient. The onset of ICU psychosis is usually rapid, and is upsetting and frightening to the patient and family members.
First steps to treat ICU psychosis are usually to re-orient a
critically ill Patient and also to try and get Patients back to a regular day and night rhythm.
Anti-psychotic agents such as Olanzapine, Seroquel or Haloperidol may help as well.
Often ICU Psychosis disappears when Patients are being discharged to a hospital ward.
The strange and unusual combination of Intensive Care treatment, prolonged
induced coma, prolonged critical illness, the noise levels, the lack of sleep, the constant disturbances etc… put long-term ICU Patients at increased risk to develop ICU Psychosis.
I hope this helps and clarifies the side effects of an induced coma.
See you next week!
