Tracheostomy patient not waking up after sedation in ICU , covid came negative.

[utkarsh_rastogi]

Hello All,

I am taking care of my father in law(63 years and diabetic) who had Pyriform fossa (cancer stage 4A) had a treatment 3 weeks ago (30th June 2020) which consist of tracheostomy as part of total laryngectomy (voice chords are removed) alongwith PMMAC flap and partial thyroidectomy.

He did fine till 2-3 days after that and was able to walk even after this critical surgery. But on 2nd July 2020 he had mild fever which continued for another 2 nights , so the doctors advised for a COVID test which unfortunately came out to be postive.

I was devastated and so my was father in law. After taking every little precaution he got COVID inside the hospital and still we dont know about the reason of infection ( there could be a zillion possibilities that we understood) .

However later that day when the reports came , he was shifted to an isolated ward as he was not showing any symptoms (not even fever) which was a relief. But a day after that he developed some breathing issues which deteriorated his condition. He was then shifted to COVID ICU and was put on ventilator (pressure based) on the night of 11th July 2020.

Sometimes we hear from the ICU that he is improving , but sometimes his saturation becomes very low and they had put him to ventilator (full support) again on the night of 13th July 2020.

He wanted to see us , talk to us and tell us about his condition but we were not allowed in the COVID ICU. Video calls were the only hope.

He was very angry and agitated as he did not expect this at all in his life. Before his surgery, he was a man with great taste and a food connoisseur but now he had just a pipe running through his nose providing RTF (ready to feed)and clear liquids.

Since there was so much be ventilation required, the doctors asked to prepare him for OT again to see why is he unable to breathe and sometimes his trach comes out.

These days were very difficult for us and we could not visit him.

During this time we thought that these issues might have happened due to COVID-19 , but the next test came out to be negative on 18th July 2020 which ruled out the possibility of COVID symptoms.

On the night of 18th July 2020, his BP came very low (40/70). He was maintaing 97 % SPO2 but only while he was on ventilator. His sugar frequently oscillates from 90 -300 which is controlled by Insulin.

So Yesterday (20th July 2020) @11:30 AM , the doctors scheduled the minor surgery before which he was under sedation and a local anaesthesia was given for his surgery.

The doctors could not find airway blockages or any seepage into his trachea in order to find out the root cause of his breathing issues. All they could find out was some mucus so they sucked it all out.

Last night he had some siezures and BP was low again.

Till today 21st July 2020 he has not come into his consciousness. They stopped the sedation at 10:30 AM today . But still we are waiting for him to get up and move his hands and talk something.

Doctors are suggesting to go for an MRI to see if there are changes in the brain as they are suspecting lack of oxygen into his brain or could be septic, but in order to do MRI he needs to be awake.

He is still on full ventilator support and drugs to keep his BP normalised. His feed is going fine but reduced from before.

Is anyone aware of what has happened and whether my father will be fine ? During his cancer journey of 22 days (till today) , we have not heard a news which brought a smile on our face.

His health is deteroriating and we are just praying everyday and hoping to see some improvements and he doesn't have voice but a million thoughts to convey.

Please drop your comments and suggestions if any.

Thank you all.

UT

[FamilyHistorian]

Hi

I don’t know anything about your father in laws specific conditions. What I can tell you is I am 72 and went into hospital towards the end of last year, had a heart op before Christmas and then was sedated / ventilated for 6-8 weeks. I had a trachy and was fed by tube. I woke when I was ready and that seems to be a trend. Everyone is different.

You must look after yourself as well! ICUSteps clan point you in the right direction

Thinking of you

[utkarsh_rastogi in reply to FamilyHistorian]

Thank you sir for your kind words.

I am just hoping that he walked through that door same way he entered the hospital.

[Sepsur in reply to utkarsh_rastogi]

Hi utkarsh_rastogi

The platform might decide to send you my 2 earlier attempts to reply to you ( if you get bombarded)

I hope your father-in-law comes through all of the challenges that lie ahead for him.

This is a link to a whole load of pdfs for you to have a realistic picture of what lays ahead for your family.

icustepschester.org/informa...

In reply to your comment about wishing he would be the same person at the end of all this.

I can only speak from my own experience - I believe the whole diabolical rollercoaster of critical care altered our family for ever BUT I want to stress, not all aspects were negative.

The physical legacies of critical illness are most obvious but the emotional & mental results are equally challenging.

We have discovered ( as a family) that we are more robust, decent & dignified than we would have thought.

Let us know how you all get on

[utkarsh_rastogi in reply to Sepsur]

Thank you Sepsur for providing the information.

There is a lot of going on his body currently. Today the vitals are normal but he is still on ventilator and it's been 48 hours now and he is not awake. His stimuli response rate is 3 whereas as an active person response rate is 15.

I met him today and said that he needs to get up at any cost and improve, trying to motivate him. I don't know whether he is listening but I just don't want to leave any stone unturned.

Just waiting every moment to get a call from hospital saying that he has resumed his consciousness.

[Sepsur in reply to utkarsh_rastogi]

Everybody responds to the sedatives in a different manner & it can take some people awhile to come round. I believe it took me 11 days from the moment that the sedatives were removed.

[utkarsh_rastogi in reply to Sepsur]

His GCS is 3 which is the least. Is it a state of COMA ?

[Sepsur in reply to utkarsh_rastogi]

I believe that stands for Glasgow Coma Scale - 3 means a deep coma & 15 means fully awake.

How I understand the scoring system is that it is broken into 3 sections

Eye movement, verbal ability to respond and motor responses - like coughing, stretching, yawning etc etc

Each section is scored from 1-5 - hence deep coma is 3 ie 1 from each section.

Rhyl1 might clarify better 😊

[utkarsh_rastogi in reply to Sepsur]

You are correct . I even asked doctors about it but they think it's too early to arrive to conclusions. First they did a CT today which they feel is not conclusive enough.

The doctors want to assure that there are no hypoxy injury or any kind of lesion in his brain.

So after that they did an MRI after controlling his low BP and also did EEG.

Still on ventilator 40% O2 .

Reports will come tomorrow morning . I am just praying for him to show some sign that he is still fighting and I know he will show as he had the zeal to live. 😞😞

[Sepsur in reply to utkarsh_rastogi]

I was comatose for 57 days, they feared hypoxia with me. CT scan & MRi were inconclusive too. It took me eleven more days to fully come round after sedation was removed. Although I have cognitive dysfunction & my mental processes are different as a consequence of being critically ill - I have a good life. I hope over the next few days, you have better news.

[utkarsh_rastogi in reply to Sepsur]

Thank you so much for your kind words. They are really helpful , whenever I see your message , I read it out loud among my family members as they feel relieved too.

Hoping to see some better news tomorrow.

[Sepsur in reply to utkarsh_rastogi]

There are many many people who have defied the odds on this very forum, my family were told on several occasions to come a say their goodbyes because I would not survive the night. Well that was 4yrs ago. Whilst your loved one is still alive, there is hope. Best wishes for the next few days.

[utkarsh_rastogi in reply to Sepsur]

Today , I saw his eyes moving left to right not sure whether he was able to listen to me. But I asked him to stay strong and fight.

Still on ventilator 40% O2. Sedation still going 1 ml (they told) i.e mild sedation.

MRI and EEG reports will come in an hour.

[utkarsh_rastogi in reply to utkarsh_rastogi]

Doctors told that MRI shows hypoxia injury in the brain due to low BP , the injury has already happened 2 days before which is not a good sign , but we will monitor him for 2 days.

If nothing is improved then we may need to talk for some alternative. 😞

[utkarsh_rastogi in reply to utkarsh_rastogi]

I know what they are going to say 😞.

I don't want them to say after 48hours that we can't save him now.

[Sepsur in reply to utkarsh_rastogi]

Hopefully they will come up with a better conclusion in a day or two. One has to hope - many of us who have survived have had dire prognosis

[utkarsh_rastogi in reply to Sepsur]

So now finally the day has come where the doctors said that due to severe hypoxia ischemic injury , his brain is approximately 90% dead. The only thing he could do is sometimes to move his pupils a bit and some tongue movement.

The doctors told that legally they couldn't take his life support off. But we need to decide whether we would want to continue or let the patient go. 😞

We decided not to turn off the ventilator and let him at least for whatever life god has given him.

He wanted to live !! 😞

[Sepsur in reply to utkarsh_rastogi]

I am so sorry, that is devastating news for you, when you stated his GCS, I feared the worst. What an awful position for you all. I hope you find peace in the decisions that you make.

[utkarsh_rastogi in reply to Sepsur]

Unlike doctors, I just don't want to give up hope on him. His wife has Huntington Disease so she can't come and we are all in a different city where he is admitted.

It's really tough for us to take any decision right now. Everyone is just asking us to give the permission to just cut off the ventilator.

But "who are we to take his life from him" ?

He fought cancer , he fought COVID and now this , I think he may be fighting now even.

I have read that Sepsur you got up after 11 days or so. I am just not ready to give up on him .

[Sepsur in reply to utkarsh_rastogi]

I was in a coma for 57 days and yes it took me 11 further days to become conscious enough to understand that I was in a facility of some sort.

It took me weeks & weeks of continual and concerted physiotherapy to ‘get up’ - I had suffered such severe muscle waste. My family were told on quite a few occasions that it was hopeless & to come in & say their goodbyes. It is true - no-one gave up on me. I hope you get more promising news.

[utkarsh_rastogi in reply to Sepsur]

So now he is discharged but doctors are saying that he is in a state of irreversible coma. As currently we shifted him to a palliative care center. Though they are taking good care of him but unfortunately he is developing some ved sores and since his body is not moving so , he is losing protein from his body as the albumin levels came down really low to 2.0

He is on albumin injections and currently on Oxygen as he is unable to maintain the oxygen saturation.

The doctors have lost their hope and they sometimes tell others that we are just burning money on him.

We know that now after nearly 50 days of hospitalization , he has not shown any postive signs on recovery, but still we are waiting for that 1% chance of miracle.

Out of the blue looking at his condition a doctor suggested to test zolpiderm on him. He says it might be the only chance to bring him in to his senses but risk factor is that he may collapse.

Does any one know about zolpiderm being given to coma patients ?

[Sepsur in reply to utkarsh_rastogi]

Hi @utkarsh_rastogi - I am very sorry to read this outcome for your father-in-law, I know how unwell his wife is too.

I would copy your comment above, (instead of it being part of a thread) and repost it as a new post - at present, you have answered my previous comment and I don’t think anyone will necessarily see your question to answer it.

I’m sorry I have no experience that can be of any help.

[Sepsur in reply to utkarsh_rastogi]

Here is a link too but you may have already read it.

pubmed.ncbi.nlm.nih.gov/234...