Processes after traceostomy

[Beanyynwa]

My sister is 55 years old and has been in ICU and on ventilator since 26th February. Main issue has been the impact of COVID on her lungs. Other organs are fine. She has had several bacterial infections and responded well to antibiotics. Whilst on ventilator her oxygen requirement fluctuated between 90% and 45%. Initially her requirement was high and she needed a high level of pressure into her lungs. This decreased over time and the ventilator was on spontaneous mode. She had a traceostomy last Wednesday and initially there was a set back in terms of her oxygen requirement increasing to 80%, which we were told sometimes happens. Doctors were not going to reduce her sedation until her oxygen requirement lowered and stabilised. When my sister visited her yesterday (Friday) she appeared more responsive than previously. I spoke to her by phone and when I blew her kisses, she pursed her lips and tried to send me kisses. ❤😘 She responded to questions and conversations by nodding or shaking her head. Staff were amazed and happy about this. The head of the unit feels that the twice weekly visits have helped and he is willing to explore increasing visits to daily visits.

My sister continues to respond appropriately to questions from staff and her oxygen requirement has gradually reduced to 45% today. She is not sleeping well at night but nurses report that she is calm and does not appear agitated. Before she became ill, my sister was a nocturnal person who often stayed up til the early hours. I don't know whether this has any impact.

We are delighted with the progress she has made but realise that there is a long way to go and that setbacks are likely. We know that everyone is unique but it would be useful to know more about the process going forward, what might happen, what to expect and be mindful of.

Thank you very much

[Sepsur]

I think your sister’s previous sleep patterns are significant and the staff should be made aware because what she does naturally is significant for her diurnal rhythms. A person’s daily or Circadian rhythms affect your metabolism, production of hormones and immune system and are frequently disrupted in patients in the ICU. They also modulate how affectively the body responds to injury and illness which can impact recovery. People are thrown out of kilter by the abnormal lighting, noise, different ways you are fed, regular obs, care interactions and administering of medications. Everyone is realising that normalisation of circadian rhythms in critically ill patients is extremely desirable & may be an important part of ICU care, possibly more significant in the likelihood of delirium than previously thought. Sleep disorders are an unwelcome travelling partner for many of us after ICU.

[FamilyHistorian]

In addition to what @sepsur said my O2 levels fluctuated and the icu that I was in was more concerned about me becoming stable. At some point they may fit a speaking valve but only for short periods of time as to use it is very tiring and on the other hand when it is taken away it is very frustrating as your new voice is taken away. Eventually it will be removed and allowed the heal with just a dressing on it. This too may take several weeks.

Yes the previous sleep pattern is important I have heard of cases of lorry drivers who only work nights having problems. On the other hand there may be some delirium working away in the background. I was afraid to go to sleep at night in case o didn’t wake up!

[Beanyynwa in reply to FamilyHistorian]

Thank you both for your responses. I have informed nurses of her previous sleep pattern and will reinforce this when I speak with doctors. She is on 40% oxygen requirement today and I am told that she is needing less support from the ventilator. They have removed lots of secretions from her lungs over the last two days. I have asked that they play her Coldplay songs during the day because she loves the band. I have also asked that they play her relaxation and mindfulness music in the evening to help her relax and sleep. I am of the firm view that regular visits from us will play a crucial part in her recovery.